Chapter 67- Musculoskeletal Care Modalities

Chapter 67- Musculoskeletal Care Modalities Brunner: Medical-Surgical Nursing, 11th Edition Test Bank Chapter 67: Musculoskeletal Care Modalities Multiple Choice 1. The nurse is caring for a patient who has had a plaster leg cast applied. Immediately postapplication, the nurse should inform the patient that: A) The cast will cool in 5 minutes. B) The cast should be covered with a towel. C) The cast should be supported on a board while drying. D) The cast will only have full strength when dry. Ans: D Chapter: 67 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Patient Needs: D-1 Feedback: A cast requires approximately 24 to 72 hours to dry, and until dry, it does not have full strength. While drying, the cast should not be placed on a hard surface. The initial cooling occurs in about 15 minutes after application of the cast. 2. A male patient with an arm cast states that he is unable to straighten his fingers. The nurse notes that the patient is experiencing Volkmann's contracture, which is due to: A) Obstructed arterial blood flow to the forearm and hand B) Obstructed venous blood flow from the forearm and hand C) The cast being applied too loosely D) Muscle spasm of the forearm Ans: A Chapter: 67 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Patient Needs: D-4 Feedback: Volkmann's contracture occurs when arterial blood flow is restricted to the forearm and hand and results in contractures of the fingers and wrist. 3. The nurse has administered analgesics and elevates the limb for a patient complaining of pain to the leg, which is casted. Thirty minutes after administering the analgesics, the patient states the pain is unrelieved. This may be a sign of: A) Edema B) A pressure ulcer C) Compartment syndrome D) Disuse syndrome Ans: C Chapter: 67 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Patient Needs: D-4 Feedback: Compartment syndrome may manifest as unrelenting, uncontrollable pain. Discomfort from edema may be relieved with elevation of the limb; pain from ulcers is usually relieved when ulceration occurs. Disuse syndrome may result in disuse atrophy. 4. The nurse is assessing a patient presenting with a lower extremity fracture. Which of the following signs and symptoms best represents peroneal nerve injury? A) Numbness and burning of the foot B) Numbness and burning of the hand C) Cyanotic toes D) Inadequate capillary refill Ans: A Chapter: 67 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 2 Patient Needs: D-4 Feedback: Peroneal nerve injury may result in numbness, tingling and burning in the feet. Cyanosis and decreased capillary refill are signs of inadequate circulation. 5. When instructing a patient who is being discharged with a leg cast, the most appropriate information for the nurse to give the patient is: A) Use a knitting needle to scratch under the cast. B) Keep the cast covered with a plastic bag to prevent moisture damage. C) If any part of the cast breaks, glue it immediately. D) Cushion the rough edges of the cast with tape. Ans: D Chapter: 67 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Patient Needs: D-1 Feedback: The patient should cushion the rough edges of the cast with tape, never scratch under the cast, report a broken cast but do not attempt to fix it, and avoid covering the cast with plastic because this traps moisture. 6. After a cast is removed, the best nursing intervention is: A) Placing the limb in a dependent position B) Encouraging the patient to exfoliate dry skin by scratching C) Encouraging the patient to resume activity gradually D) Avoiding emollient on the area that was immobilized Ans: C Chapter: 67 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Patient Needs: D-3 Feedback: When removing a cast, interventions include encouraging the patient to resume activity gradually, elevating the affected limb, and applying emollient to the skin of the limb that was immobilized and avoid scratching it. 7. The most appropriate type of traction to apply to a fractured proximal femur is: A) Russell's traction B) Dunlop's traction C) Buck's extension traction D) Cervical head halter Ans: C Chapter: 67 Cognitive Level: Knowledge Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Patient Needs: D-1 Feedback: Buck's extension is used for fractures of the proximal femur. Dunlop's traction is applied to the upper extremity for supracondylar fractures of the elbow and humerus. Russell's is used for lower leg fractures. Cervical head halters are used to treat back pain. 8. The nurse is applying traction to a patient. Which of the following is an appropriate example of proper traction use? A) Knots in the rope should not be resting against pulleys. B) Weights should rest against the bed rails. C) The end of the limb in traction should be resting against the bed's footboard. D) Skeletal traction may be removed. Ans: A Chapter: 67 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Patient Needs: D-3 Feedback: Knots in the rope should not rest against pulleys, because this interferes with traction. Weights are used to apply the vector of force necessary to achieve effective traction and should hang freely at all times. To avoid interrupting traction, the limb in traction should not rest against anything. Skeletal traction is never interrupted.