Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 63

Chapter 63: Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery
Test Bank
MULTIPLE CHOICE
1. When teaching seniors at a community recreation center, which information will the nurse
include about ways to prevent fractures?
a. Tack down scatter rugs in the home.
b. Most falls happen outside the home.
c. Buy shoes that provide good support and are comfortable to wear.
d. Range-of-motion exercises should be taught by a physical therapist.
ANS: C
Comfortable shoes with good support will help decrease the risk for falls. Scatter rugs should
be eliminated, not just tacked down. Activities of daily living provide range of motion
exercise; these do not need to be taught by a physical therapist. Falls inside the home are
responsible for many injuries.
DIF: Cognitive Level: Apply (application) REF: 1506

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment
2. A factory line worker has repetitive strain syndrome in the left elbow. The nurse will plan to
teach the patient about
a. surgical options.
b. elbow injections.
c. wearing a left wrist splint.
d. modifying arm movements.
ANS: D
Treatment for repetitive strain syndrome includes changing the ergonomics of the activity.
Elbow injections and surgery are not initial options for this type of injury. A wrist splint might
be used for hand or wrist pain.

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
3. The occupational health nurse will teach the patient whose job involves many hours of typing
about the need to
a. obtain a keyboard pad to support the wrist.
b. do stretching exercises before starting work.
c. wrap the wrists with compression bandages every morning.
d. avoid using nonsteroidal antiinflammatory drugs (NSAIDs) for pain.
ANS: A
Repetitive strain injuries caused by prolonged times working at a keyboard can be prevented
by the use of a pad that will keep the wrists in a straight position. Stretching exercises during
the day may be helpful, but these would not be needed before starting. Use of a compression
bandage is not needed, although a splint may be used for carpal tunnel syndrome. NSAIDs are
appropriate to use to decrease swelling.
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
4. Which discharge instruction will the emergency department nurse include for a patient with a
sprained ankle?
a. Keep the ankle loosely wrapped with gauze.
b. Apply a heating pad to reduce muscle spasms.
c. Use pillows to elevate the ankle above the heart.
d. Gently move the ankle through the range of motion.
ANS: C
Elevation of the leg will reduce the amount of swelling and pain. Compression bandages are
used to decrease swelling. For the first 24 to 48 hours, cold packs are used to reduce swelling.
The ankle should be rested and kept immobile to prevent further swelling or injury.

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
5. A 22-year-old tennis player has an arthroscopic repair of a rotator cuff injury performed in
same-day surgery. When the nurse plans postoperative teaching for the patient, which
information will be included?
a. You will not be able to serve a tennis ball again.
b. You will work with a physical therapist tomorrow.
c. The doctor will use the drop-arm test to determine the success of surgery.
d. Leave the shoulder immobilizer on for the first 4 days to minimize pain.
ANS: B
Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent
frozen shoulder. A shoulder immobilizer is used immediately after the surgery, but leaving
the arm immobilized for several days would lead to loss of range of motion (ROM). The drop-
arm test is used to test for rotator cuff injury, but not after surgery. The patient may be able to
return to pitching after rehabilitation.

6. The nurse will instruct the patient with a fractured left radius that the cast will need to remain
in place
a. for several months.
b. for at least 3 weeks.
c. until swelling of the wrist has resolved.
d. until x-rays show complete bony union.
ANS: B
Bone healing starts immediately after the injury, but since ossification does not begin until 3
weeks postinjury, the cast will need to be worn for at least 3 weeks. Complete union may take
up to a year. Resolution of swelling does not indicate bone healing.

7. A 48-year-old patient with a comminuted fracture of the left femur has Bucks traction in
place while waiting for surgery. To assess for pressure areas on the patients back and sacral
area and to provide skin care, the nurse should
a. loosen the traction and help the patient turn onto the unaffected side.
b. place a pillow between the patients legs and turn gently to each side.
c. turn the patient partially to each side with the assistance of another nurse.
d. have the patient lift the buttocks by bending and pushing with the right leg.
ANS: D
The patient can lift the buttocks off the bed by using the left leg without changing the right-leg
alignment. Turning the patient will tend to move the leg out of alignment. Disconnecting the
traction will interrupt the weight needed to immobilize and align the fracture.
DIF: Cognitive Level: Apply (application) REF: 1514 | 1520

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment
8. Which nursing intervention will be included in the plan of care after a patient with a right
femur fracture has a hip spica cast applied?
a. Avoid placing the patient in prone position.
b. Ask the patient about abdominal discomfort.
c. Discuss remaining on bed rest for several weeks.
d. Use the cast support bar to reposition the patient.
ANS: B
Assessment of bowel sounds, abdominal pain, and nausea and vomiting will detect the
development of cast syndrome. To avoid breakage, the support bar should not be used for
repositioning. After the cast dries, the patient can begin ambulating with the assistance of
physical therapy personnel and may be turned to the prone position.

9. A patient has a long-arm plaster cast applied for immobilization of a fractured left radius.
Until the cast has completely dried, the nurse should
a. keep the left arm in dependent position.
b. avoid handling the cast using fingertips.
c. place gauze around the cast edge to pad any roughness.
d. cover the cast with a small blanket to absorb the dampness.
ANS: B
Until a plaster cast has dried, using the palms rather than the fingertips to handle the cast helps
prevent creating protrusions inside the cast that could place pressure on the skin. The left arm
should be elevated to prevent swelling. The edges of the cast may be petaled once the cast is
dry, but padding the edges before that may cause the cast to be misshapen. The cast should not
be covered until it is dry because heat builds up during drying.

10. Which statement by the patient indicates a good understanding of the nurses teaching about a
new short-arm plaster cast?
a. I can get the cast wet as long as I dry it right away with a hair dryer.
b. I should avoid moving my fingers and elbow until the cast is removed.
c. I will apply an ice pack to the cast over the fracture site off and on for 24 hours.
d. I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast.
ANS: C
Ice application for the first 24 hours after a fracture will help reduce swelling and can be
placed over the cast. Plaster casts should not get wet. The patient should be encouraged to
move the joints above and below the cast. Patients should not insert objects inside the cast.

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
11. A patient who is to have no weight bearing on the left leg is learning to walk using crutches.
Which observation by the nurse indicates that the patient can safely ambulate independently?
a. The patient moves the right crutch with the right leg and then the left crutch with
the left leg.
b. The patient advances the left leg and both crutches together and then advances the
right leg.
c. The patient uses the bedside chair to assist in balance as needed when ambulating
in the room.
d. The patient keeps the padded area of the crutch firmly in the axillary area when
ambulating.
ANS: B
Patients are usually taught to move the crutches and the injured leg forward at the same time
and then to move the unaffected leg. Patients are discouraged from using furniture to assist
with ambulation. The patient is taught to place weight on the hands, not in the axilla, to avoid
nerve damage. If the 2- or 4-point gaits are to be used, the crutch and leg on opposite sides
move forward, not the crutch and same-side leg.

TOP: Nursing Process: Evaluation MSC: NCLEX: Safe and Effective Care Environment
12. A 32-year-old patient who has had an open reduction and internal fixation (ORIF) of left
lower leg fractures continues to complain of severe pain in the leg 15 minutes after receiving
the prescribed IV morphine. Pulses are faintly palpable and the foot is cool. Which action
should the nurse take next?
a. Notify the health care provider.
b. Assess the incision for redness.
c. Reposition the left leg on pillows.
d. Check the patients blood pressure.
ANS: A
The patients clinical manifestations suggest compartment syndrome and delay in diagnosis
and treatment may lead to severe functional impairment. The data do not suggest problems
with blood pressure or infection. Elevation of the leg will decrease arterial flow and further
reduce perfusion.

13. A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which
nursing assessment finding is important to report to the health care provider?
a. The patient states that the pelvis feels unstable.
b. Abdomen is distended and bowel sounds are absent.
c. There are ecchymoses across the abdomen and hips.
d. The patient complains of pelvic pain with palpation.
ANS: B
The abdominal distention and absent bowel sounds may be due to complications of pelvic
fractures such as paralytic ileus or hemorrhage or trauma to the bladder, urethra, or colon.
Pelvic instability, abdominal pain with palpation, and abdominal bruising would be expected
with this type of injury.

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
14. Which action will the nurse take in order to evaluate the effectiveness of Bucks traction for a
62-year-old patient who has an intracapsular fracture of the right femur?
a. Check peripheral pulses.
b. Ask about hip pain level.
c. Assess for hip contractures.
d. Monitor for hip dislocation.
ANS: B
Bucks traction keeps the leg immobilized and reduces painful muscle spasm. Hip
contractures and dislocation are unlikely to occur in this situation. The peripheral pulses will
be assessed, but this does not help in evaluating the effectiveness of Bucks traction.

15. A patient with a right lower leg fracture will be discharged home with an external fixation
device in place. Which information will the nurse teach?
a. You will need to check and clean the pin insertion sites daily.
b. The external fixator can be removed for your bath or shower.
c. You will need to remain on bed rest until bone healing is complete.
d. Prophylactic antibiotics are used until the external fixator is removed.
ANS: A
Pin insertion sites should be cleaned daily to decrease the risk for infection at the site. An
external fixator allows the patient to be out of bed and avoid the risks of prolonged
immobility. The device is surgically placed and is not removed until the bone is stable.
Prophylactic antibiotics are not routinely given when an external fixator is used.

16. A patient who has had an open reduction and internal fixation (ORIF) of a hip fracture tells
the nurse that he is ready to get out of bed for the first time. Which action should the nurse
take?
a. Use a mechanical lift to transfer the patient from the bed to the chair.
b. Check the postoperative orders for the patients weight-bearing status.
c. Avoid administration of pain medications before getting the patient up.
d. Delegate the transfer of the patient to nursing assistive personnel (NAP).
ANS: B
The nurse should be familiar with the weight-bearing orders for the patient before attempting
the transfer. Mechanical lifts are not typically needed after this surgery. Pain medications
should be given because the movement is likely to be painful for the patient. The registered
nurse (RN) should supervise the patient during the initial transfer to evaluate how well the
patient is able to accomplish this skill.

17. When doing discharge teaching for a 19-year-old patient who has had a repair of a fractured
mandible, the nurse will include information about
a.administration of nasogastric tube feedings.
b.how and when to cut the immobilizing wires.
c.the importance of high-fiber foods in the diet.
d.the use of sterile technique for dressing changes.
ANS: B
The jaw will be wired for stabilization, and the patient should know what emergency
situations require that the wires be cut to protect the airway. There are no dressing changes for
this procedure. The diet is liquid, and patients are not able to chew high-fiber foods. Initially,
the patient may receive nasogastric tube feedings, but by discharge, the patient will swallow
liquid through a straw.
DIF: Cognitive Level: Apply (application) REF: 1529-1530

18. After the health care provider has recommended amputation for a patient who has nonhealing
ischemic foot ulcers, the patient tells the nurse that he would rather die than have an
amputation. Which response by the nurse is best?
a. You are upset, but you may lose the foot anyway.
b. Many people are able to function with a foot prosthesis.
c. Tell me what you know about your options for treatment.
d. If you do not want an amputation, you do not have to have it.
ANS: C
The initial nursing action should be to assess the patients knowledge level and feelings about
the options available. Discussion about the patients option to not have the procedure, the
seriousness of the condition, or rehabilitation after the procedure may be appropriate after the
nurse knows more about the patients current level of knowledge and emotional state.

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
19. The day after a having a right below-the-knee amputation, a patient complains of pain in the
right foot. Which action is best for the nurse to take?
a. Explain the reasons for the phantom limb pain.
b. Administer prescribed analgesics to relieve the pain.
c. Loosen the compression bandage to decrease incisional pressure.
d. Inform the patient that this phantom pain will diminish over time.
ANS: B
Phantom limb sensation is treated like any other type of postoperative pain would be treated.
Explanations of the reason for the pain may be given, but the nurse should still medicate the
patient. The compression bandage is left in place except during physical therapy or bathing.
Although the pain may decrease over time, it still requires treatment now.
DIF: Cognitive Level: Understand (comprehension) REF: 1532

20. Which statement by a 62-year-old patient who has had an above-the-knee amputation
indicates that the nurses discharge teaching has been effective?
a. I should elevate my residual limb on a pillow 2 or 3 times a day.
b. I should lay flat on my abdomen for 30 minutes 3 or 4 times a day.
c. I should change the limb sock when it becomes soiled or each week.
d. I should use lotion on the stump to prevent skin drying and cracking.
ANS: B
The patient lies in the prone position several times daily to prevent flexion contractures of the
hip. The limb sock should be changed daily. Lotion should not be used on the stump. The
residual limb should not be elevated because this would encourage flexion contracture.

21. The nurse is caring for a patient who is to be discharged from the hospital 5 days after
insertion of a femoral head prosthesis using a posterior approach. Which statement by the
patient indicates a need for additional instruction?
a. I should not cross my legs while sitting.
b. I will use a toilet elevator on the toilet seat.
c. I will have someone else put on my shoes and socks.
d. I can sleep in any position that is comfortable for me.
ANS: D
The patient needs to sleep in a position that prevents excessive internal rotation or flexion of
the hip. The other patient statements indicate that the patient has understood the teaching.

22. Which action will the nurse include in the plan of care for a patient who has had a total right
knee arthroplasty?
a. Avoid extension of the right knee beyond 120 degrees.
b. Use a compression bandage to keep the right knee flexed.
c. Teach about the need to avoid weight bearing for 4 weeks.
d. Start progressive knee exercises to obtain 90-degree flexion.
ANS: D
After knee arthroplasty, active or passive flexion exercises are used to obtain a 90-degree
flexion of the knee. The goal for extension of the knee will be 180 degrees. A compression
bandage is used to hold the knee in an extended position after surgery. Full weight bearing is
expected before discharge.

23. A high school teacher with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for a
left hand arthroplasty. Which patient statement to the nurse indicates a realistic expectation for
the surgery?
a. This procedure will correct the deformities in my fingers.
b. I will not have to do as many hand exercises after the surgery.
c. I will be able to use my fingers with more flexibility to grasp things.
d. My fingers will appear more normal in size and shape after this surgery.
ANS: C
The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or
treat the underlying process. Hand exercises will be prescribed after the surgery.

24. When giving home care instructions to a patient who has comminuted forearm fractures and a
long-arm cast on the left arm, which information should the nurse include?
a. Keep the left shoulder elevated on a pillow or cushion.
b. Keep the hand immobile to prevent soft tissue swelling.
c. Call the health care provider for increased swelling or numbness of the hand.
d. Avoid nonsteroidal antiinflammatory drugs (NSAIDs) for 24 hours after the injury.
ANS: C
Increased swelling or numbness may indicate increased pressure at the injury, and the health
care provider should be notified immediately to avoid damage to nerves and other tissues. The
patient should be encouraged to move the joints above and below the cast to avoid stiffness.
There is no need to elevate the shoulder, although the forearm should be elevated to reduce
swelling. NSAIDs are appropriate to treat pain after a fracture.

25. A patient who slipped and fell in the shower at home has a proximal humerus fracture
immobilized with a left-sided long-arm cast and a sling. Which nursing intervention will be
included in the plan of care?
a. Use surgical net dressing to hang the arm from an IV pole.
b. Immobilize the fingers of the left hand with gauze dressings.
c. Assess the left axilla and change absorbent dressings as needed.
d. Assist the patient in passive range of motion (ROM) for the right arm.
ANS: C
The axilla can become excoriated when a sling is used to support the arm, and the nurse
should check the axilla and apply absorbent dressings to prevent this. A patient with a sling
would not have traction applied by hanging. The patient will be encouraged to move the
fingers on the injured arm to maintain function and to help decrease swelling. The patient will
do active ROM on the uninjured side.

26. A patient is being discharged 4 days after hip replacement surgery using the posterior
approach. Which patient action requires immediate intervention by the nurse?
a. The patient uses crutches with a swing-to gait.
b. The patient leans over to pull shoes and socks on.
c. The patient sits straight up on the edge of the bed.
d. The patient bends over the sink while brushing teeth.
ANS: B
Leaning over would flex the hip at greater than 90 degrees and predispose the patient to hip
dislocation. The other patient actions are appropriate and do not require any immediate action
by the nurse to protect the patient.

27. After being hospitalized for 3 days with a right femur fracture, a 32-year-old patient suddenly
develops shortness of breath and tachypnea. The patient tells the nurse, I feel like I am going
to die! Which action should the nurse take first?
a. Stay with the patient and offer reassurance.
b. Administer the prescribed PRN oxygen at 4 L/min.
c. Check the patients legs for swelling or tenderness.
d. Notify the health care provider about the symptoms.
ANS: B
The patients clinical manifestations and history are consistent with a pulmonary embolus, and
the nurses first action should be to ensure adequate oxygenation. The nurse should offer
reassurance to the patient, but meeting the physiologic need for oxygen is a higher priority.
The health care provider should be notified after the oxygen is started and pulse oximetry and
assessment for fat embolus or venous thromboembolism (VTE) are obtained.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
28. A patient arrived at the emergency department after tripping over a rug and falling at home.
Which finding is most important for the nurse to communicate to the health care provider?
a.There is bruising at the shoulder area.
b.The patient reports arm and shoulder pain.
c.The right arm appears shorter than the left.
d.There is decreased shoulder range of motion.
ANS: C
A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency.
Bruising, pain, and decreased range of motion also should be reported, but these do not
indicate that emergent treatment is needed to preserve function.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
29. A young man arrives in the emergency department with ankle swelling and severe pain after
twisting his ankle playing basketball. Which of these prescribed collaborative interventions
will the nurse implement first?
a. Take the patient to have x-rays.
b. Wrap the ankle and apply an ice pack.
c. Administer naproxen (Naprosyn) 500 mg PO.
d. Give acetaminophen with codeine (Tylenol #3).
ANS: B
Immediate care after a sprain or strain injury includes the application of cold and compression
to the injury to minimize swelling. The other actions should be taken after the ankle is
wrapped with a compression bandage and ice is applied.

30. Which nursing action for a patient who has had right hip replacement surgery can the nurse
delegate to experienced unlicensed assistive personnel (UAP)?
a. Reposition the patient every 1 to 2 hours.
b. Assess for skin irritation on the patients back.
c. Teach the patient quadriceps-setting exercises.
d. Determine the patients pain level and tolerance.
ANS: A
Repositioning of orthopedic patients is within the scope of practice of UAP (after they have
been trained and evaluated in this skill). The other actions should be done by licensed nursing
staff members.

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
31. A patient who arrives at the emergency department experiencing severe left knee pain is
diagnosed with a patellar dislocation. The initial patient teaching by the nurse will focus on
the need for
a. a knee immobilizer.
b. gentle knee flexion.
c. monitored anesthesia care.
d. physical activity restrictions.
ANS: C
The first goal of collaborative management is realignment of the knee to its original anatomic
position, which will require anesthesia or monitored anesthesia care (MAC), formerly called
conscious sedation. Immobilization, gentle range-of-motion (ROM) exercises, and discussion
about activity restrictions will be implemented after the knee is realigned.

32. Following a motorcycle accident, a 58-year-old patient arrives in the emergency department
with massive left lower leg swelling. Which action will the nurse take first?
a. Elevate the leg on 2 pillows.
b. Apply a compression bandage.
c. Check leg pulses and sensation.
d. Place ice packs on the lower leg.
ANS: C
The initial action by the nurse will be to assess the circulation to the leg and to observe for any
evidence of injury such as fractures or dislocations. After the initial assessment, the other
actions may be appropriate, based on what is observed during the assessment.

33. A pedestrian who was hit by a car is admitted to the emergency department with possible right
lower leg fractures. The initial action by the nurse should be to
a. elevate the right leg.
b. splint the lower leg.
c. check the pedal pulses.
d. verify tetanus immunizations.
ANS: C
The initial nursing action should be assessment of the neurovascular status of the injured leg.
After assessment, the nurse may need to splint and elevate the leg, based on the assessment
data. Information about tetanus immunizations should be done if there is an open wound.

34. The day after a 60-year-old patient has an open reduction and internal fixation (ORIF) for an
open, displaced tibial fracture, the priority nursing diagnosis is
a. activity intolerance related to deconditioning.
b. risk for constipation related to prolonged bed rest.
c. risk for impaired skin integrity related to immobility.
d. risk for infection related to disruption of skin integrity.
ANS: D
A patient having an ORIF is at risk for problems such as wound infection and osteomyelitis.
After an ORIF, patients typically are mobilized starting the first postoperative day, so
problems caused by immobility are not as likely.
OBJ: Special Questions: Prioritization TOP: Nursing Process: Diagnosis
35. The second day after admission with a fractured pelvis, a 64-year-old patient suddenly
develops confusion. Which action should the nurse take first?
a. Take the blood pressure.
b. Assess patient orientation.
c. Check the oxygen saturation.
d. Observe for facial asymmetry.
ANS: C
The patients history and clinical manifestations suggest a fat embolus. The most important
assessment is oxygenation. The other actions are also appropriate but will be done after the
nurse assesses gas exchange.

36. A 42-year-old patient is admitted to the emergency department with a left femur fracture.
Which information obtained by the nurse is most important to report to the health care
provider?
a. Ecchymosis of the left thigh
b. Complaints of severe thigh pain
c. Slow capillary refill of the left foot
d. Outward pointing toes on the left foot
ANS: C
Prolonged capillary refill may indicate complications such as arterial damage or compartment
syndrome. The other findings are typical with a left femur fracture.

37. A patient undergoes a left above-the-knee amputation with an immediate prosthetic fitting.
When the patient arrives on the orthopedic unit after surgery, the nurse should
a.place the patient in a prone position.
b.check the surgical site for hemorrhage.
c.remove the prosthesis and wrap the site.
d.keep the residual leg elevated on a pillow.
ANS: B
The nurse should monitor for hemorrhage after the surgery. The prosthesis will not be
removed. To avoid flexion contracture of the hip, the leg will not be elevated on a pillow. The
patient is placed in a prone position after amputation to prevent hip flexion, but this would not
be done during the immediate postoperative period.

38. Before assisting a patient with ambulation 2 days after a total hip replacement, which action is
most important for the nurse to take?
a.Observe the status of the incisional drain device.
b.Administer the ordered oral opioid pain medication.
c.Instruct the patient about the benefits of ambulation.
d.Change the hip dressing and document the wound appearance.
ANS: B
The patient should be adequately medicated for pain before any attempt to ambulate.
Instructions about the benefits of ambulation may increase the patients willingness to
ambulate, but decreasing pain with ambulation is more important. The presence of an
incisional drain or timing of dressing change will not affect ambulation.

39. When assessing for Tinels sign in a patient with possible right-sided carpal tunnel syndrome,
the nurse will ask the patient about
a. weakness in the right little finger.
b. tingling in the right thumb and fingers.
c. burning in the right elbow and forearm.
d. tremor when gripping with the right hand.
ANS: B
Testing for Tinels sign will cause tingling in the thumb and first three fingers of the affected
hand in patients who have carpal tunnel syndrome. The median nerve does not innervate the
right little finger or elbow and forearm. Tremor is not associated with carpal tunnel syndrome.
DIF: Cognitive Level: Understand (comprehension) REF: 1509

40. Which action will the urgent care nurse take when caring for a patient who has a possible knee
meniscus injury?
a. Encourage bed rest for 24 to 48 hours.
b. Avoid palpation or movement of the knee.
c. Apply a knee immobilizer to the affected leg.
d. Administer intravenous narcotics for pain relief.
ANS: C
A knee immobilizer may be used for several days after a meniscus injury to stabilize the knee
and minimize pain. Patients are encouraged to ambulate with crutches. The knee is assessed
by flexing, internally rotating, and extending the knee (McMurrays test). The pain associated
with a meniscus injury will not typically require IV opioid administration; nonsteroidal
antiinflammatory drugs (NSAIDs) are usually recommended for pain relief.

41. Which finding in a patient with a Colles fracture of the left wrist is most important to
communicate to the health care provider?
a. Swelling is noted around the wrist.
b. The patient is reporting severe pain.
c. The wrist has a deformed appearance.
d. Capillary refill to the fingers is prolonged.
ANS: D
Swelling, pain, and deformity are common findings with a Colles fracture. Prolonged
capillary refill indicates decreased circulation and risk for ischemia. This is not an expected
finding and should be immediately reported.

42. Which information obtained by the nurse about a 29-year-old patient with a lumbar vertebral
compression fracture is most important to report to the health care provider?
a.Patient refuses to be turned due to back pain.
b.Patient has been incontinent of urine and stool.
c.Patient reports lumbar area tenderness to palpation.
d.Patient frequently uses oral corticosteroids to treat asthma.
ANS: B
Changes in bowel or bladder function indicate possible spinal cord compression and should be
reported immediately because surgical intervention may be needed. The other findings are
also pertinent but are consistent with the patients diagnosis and do not require immediate
intervention.

43. When a patient arrives in the emergency department with a facial fracture, which action will
the nurse take first?
a. Assess for nasal bleeding and pain.
b. Apply ice to the face to reduce swelling.
c. Use a cervical collar to stabilize the spine.
d. Check the patients alertness and orientation.
ANS: C
Patients who have facial fractures are at risk for cervical spine injury and should be treated as
if they have a cervical spine injury until this is ruled out. The other actions are also necessary,
but the most important action is to prevent cervical spine injury.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
44. After change-of-shift report, which patient should the nurse assess first?
a. Patient with a Colles fracture who has right wrist swelling and deformity
b. Patient with a intracapsular left hip fracture whose leg is externally rotated
c. Patient with a repaired mandibular fracture who is complaining of facial pain
d. Patient with right femoral shaft fracture whose thigh is swollen and ecchymotic
ANS: D
Swelling and bruising after a femoral shaft fracture suggest hemorrhage and risk for
compartment syndrome. The nurse should assess the patient rapidly and then notify the health
care provider. The other patients have symptoms that are typical for their injuries, but do not
require immediate intervention.
DIF: Cognitive Level: Analyze (analysis) REF: 1512

OBJ: Special Questions: Prioritization; Multiple Patients
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment
45. When caring for a patient who is using Bucks traction after a hip fracture, which action can
the nurse delegate to unlicensed assistive personnel (UAP)?
a. Monitor the skin under the traction boot for redness.
b. Ensure that the weight for the traction is off the floor.
c. Check for intact sensation and movement in the affected leg.
d. Offer reassurance that hip and leg pain are normal after hip fracture.
ANS: B
UAP can be responsible for maintaining the integrity of the traction once it has been
established. Assessment of skin integrity and circulation should be done by the registered
nurse (RN). UAP should notify the RN if the patient experiences hip and leg pain because
pain and effectiveness of pain relief measures should be assessed by the RN.

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
46. Based on the information shown in the accompanying figure and obtained for a patient in the
emergency room, which action will the nurse take first?
a. Administer the prescribed morphine 4 mg IV.

b. Contact the operating room to schedule surgery.
c. Check the patients oxygen saturation using pulse oximetry.
d. Ask the patient about the date of the last tetanus immunization.
ANS: C
Because fat embolism can occur with tibial fracture, the nurses first action should be to check
the patients oxygen saturation. The other actions are also appropriate, but not as important at
this time as obtaining the patients oxygen saturation.

OTHER
1. In which order will the nurse take these actions when caring for a patient in the emergency
department with a right leg fracture after a motor vehicle accident? (Put a comma and a space
between each answer choice [A, B, C, D, E, F].)
a. Obtain x-rays.
b. Check pedal pulses.
c. Assess lung sounds.
d. Take blood pressure.
e. Apply splint to the leg.
f. Administer tetanus prophylaxis.
ANS:
C, D, B, E, A, F
The initial actions should be to ensure that airway, breathing, and circulation are intact. This
should be followed by checking the neurovascular status of the leg (before and after splint
application). Application of a splint to immobilize the leg should be done before sending the
patient for x-rays. The tetanus prophylaxis is the least urgent of the actions.
DIF: Cognitive Level: Analyze (analysis) REF: 1518


Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 63

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Chapter 63: Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery

DIF: Cognitive Level: Apply (application) REF: 1506

DIF: Cognitive Level: Apply (application) REF: 1509

DIF: Cognitive Level: Apply (application) REF: 1508

DIF: Cognitive Level: Apply (application) REF: 1510

DIF: Cognitive Level: Apply (application) REF: 1513

DIF: Cognitive Level: Apply (application) REF: 1514 | 1520

DIF: Cognitive Level: Apply (application) REF: 1516

DIF: Cognitive Level: Apply (application) REF: 1515

DIF: Cognitive Level: Apply (application) REF: 1520

DIF: Cognitive Level: Apply (application) REF: 1521

DIF: Cognitive Level: Apply (application) REF: 1522

DIF: Cognitive Level: Apply (application) REF: 1524

DIF: Cognitive Level: Apply (application) REF: 1525

DIF: Cognitive Level: Apply (application) REF: 1516

DIF: Cognitive Level: Apply (application) REF: 1528

DIF: Cognitive Level: Apply (application) REF: 1529-1530

DIF: Cognitive Level: Apply (application) REF: 1531

DIF: Cognitive Level: Understand (comprehension) REF: 1532

DIF: Cognitive Level: Apply (application) REF: 1532

DIF: Cognitive Level: Apply (application) REF: 1526

DIF: Cognitive Level: Apply (application) REF: 1535

DIF: Cognitive Level: Apply (application) REF: 1535

DIF: Cognitive Level: Apply (application) REF: 1520

DIF: Cognitive Level: Apply (application) REF: 1524

DIF: Cognitive Level: Apply (application) REF: 1526

DIF: Cognitive Level: Apply (application) REF: 1528

DIF: Cognitive Level: Apply (application) REF: 1508

DIF: Cognitive Level: Apply (application) REF: 1507

DIF: Cognitive Level: Apply (application) REF: 1514

DIF: Cognitive Level: Apply (application) REF: 1508

DIF: Cognitive Level: Apply (application) REF: 1518

DIF: Cognitive Level: Apply (application) REF: 1518

DIF: Cognitive Level: Apply (application) REF: 1523

DIF: Cognitive Level: Apply (application) REF: 1517-1518

DIF: Cognitive Level: Apply (application) REF: 1532

DIF: Cognitive Level: Apply (application) REF: 1526

DIF: Cognitive Level: Understand (comprehension) REF: 1509

DIF: Cognitive Level: Apply (application) REF: 1510

DIF: Cognitive Level: Apply (application) REF: 1523-1524

DIF: Cognitive Level: Apply (application) REF: 1528

DIF: Cognitive Level: Apply (application) REF: 1529

DIF: Cognitive Level: Analyze (analysis) REF: 1512

DIF: Cognitive Level: Apply (application) REF: 1514

a. Administer the prescribed morphine 4 mg IV.

DIF: Cognitive Level: Apply (application) REF: 1523

DIF: Cognitive Level: Analyze (analysis) REF: 1518

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