Chapter 37 Management of Patients With Musculoskeletal Trauma
1. The emergency room nurse delivers a report on a patient that is arriving on the orthopedic floor
and states that the patient has a fracture of the nose that has resulted in a skin tear and involvement
of the mucous membranes of the nasal passages. The orthopedic nurse is aware that this
description likely indicates which type of fracture?
A) Compression
B) Compound C) Impacted D) Transverse
Ans: B
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Patient Needs: D-4
Feedback: A compound fracture involves damage to the skin or mucous membranes and is also
called an open fracture. A compression fracture involves compression of bone and is seen in
vertebral fractures. An impacted fracture occurs when a bone fragment is driven into another bone
fragment. A transverse fracture occurs straight across the bone shaft.
2. The nurse is preparing a care plan for a patient who has sustained a long bone fracture. Which
intervention will the nurse include in the care plan to enhance fracture healing?
A) Limit weight bearing and exercising
B) Monitor color, temperature, and pulses of the affected extremity
C) Avoid immobilization of the fracture fragments
D) Administer high doses of corticosteroids
Ans: B
,Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 6
Patient Needs: D-3
Feedback: The nurse should monitor for sufficient blood supply by assessing the color,
temperature, and pulses of the affected extremity, as adequate blood supply enhances the healing
of a fracture. Factors that inhibit fracture healing include inadequate or lack of immobilization of
the fracture fragments and administration of corticosteroids. Weight-bearing exercises are
encouraged for patients with long bone fractures.
3. An athletic patient presents to the ambulatory care facility complaining of pain in the right knee
with weight bearing. He states that two days ago he ran 10 miles and woke up the next morning
with knee pain. Upon examination, the nurse notes edema, tenderness, muscle spasms and,
ecchymosis. Based upon these symptoms, the nurse anticipates the patient has experienced a:
A) First-degree strain
B) Second-degree strain
C) First-degree sprain
D) Second-degree sprain
Ans: B
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 1
Patient Needs: D-4
Feedback: A second-degree strain involves tearing of muscle fibers and is manifested by notable
loss of load-bearing strength with accompanying edema, tenderness, muscle spasm, and
,ecchymosis. A first-degree strain involves tearing of few muscle fibers and is accompanied by
minor edema, tenderness, and mild muscle spasm, without noticeable loss of function. A first-
degree sprain is caused by tearing of few ligamentous fibers and is manifested by mild edema,
local tenderness, and pain that is elicited when the joint is moved, but there is no joint instability.
A second-degree sprain involves tearing of nerve fibers and results in increased edema,
tenderness, pain with motion, joint instability, and partial loss of normal joint function.
4. The nurse preparing the patient who has sustained a sprain of the left ankle for discharge from
the emergency room to home correctly instructs the patient to:
, A) Apply heat for the first 24 to 48 hours after injury. B) Maintain the ankle in a dependent
position.
C) Exercise hourly by performing rotation exercises of the ankle. D) Apply an elastic
compression bandage to the ankle.
Ans: D
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 2
Patient Needs: D-3
Feedback: Treatment of a sprain consists of resting and elevating the affected part, applying cold,
and using a compression bandage. After the acute inflammatory stage (usually 24 to 48 hours
after injury), heat may be applied intermittently.
5. The nurse caring for a patient with an open fracture of the radius is developing a care plan for
the patient. The nurse will assign priority to which of the following nursing diagnoses?
A) Risk for infection
B) Risk for activity intolerance
C) Risk for imbalanced nutrition, less than body requirements
D) Risk for powerlessness
Ans: A
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
Patient Needs: D-3
1. The emergency room nurse delivers a report on a patient that is arriving on the orthopedic floor
and states that the patient has a fracture of the nose that has resulted in a skin tear and involvement
of the mucous membranes of the nasal passages. The orthopedic nurse is aware that this
description likely indicates which type of fracture?
A) Compression
B) Compound C) Impacted D) Transverse
Ans: B
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Patient Needs: D-4
Feedback: A compound fracture involves damage to the skin or mucous membranes and is also
called an open fracture. A compression fracture involves compression of bone and is seen in
vertebral fractures. An impacted fracture occurs when a bone fragment is driven into another bone
fragment. A transverse fracture occurs straight across the bone shaft.
2. The nurse is preparing a care plan for a patient who has sustained a long bone fracture. Which
intervention will the nurse include in the care plan to enhance fracture healing?
A) Limit weight bearing and exercising
B) Monitor color, temperature, and pulses of the affected extremity
C) Avoid immobilization of the fracture fragments
D) Administer high doses of corticosteroids
Ans: B
,Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 6
Patient Needs: D-3
Feedback: The nurse should monitor for sufficient blood supply by assessing the color,
temperature, and pulses of the affected extremity, as adequate blood supply enhances the healing
of a fracture. Factors that inhibit fracture healing include inadequate or lack of immobilization of
the fracture fragments and administration of corticosteroids. Weight-bearing exercises are
encouraged for patients with long bone fractures.
3. An athletic patient presents to the ambulatory care facility complaining of pain in the right knee
with weight bearing. He states that two days ago he ran 10 miles and woke up the next morning
with knee pain. Upon examination, the nurse notes edema, tenderness, muscle spasms and,
ecchymosis. Based upon these symptoms, the nurse anticipates the patient has experienced a:
A) First-degree strain
B) Second-degree strain
C) First-degree sprain
D) Second-degree sprain
Ans: B
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 1
Patient Needs: D-4
Feedback: A second-degree strain involves tearing of muscle fibers and is manifested by notable
loss of load-bearing strength with accompanying edema, tenderness, muscle spasm, and
,ecchymosis. A first-degree strain involves tearing of few muscle fibers and is accompanied by
minor edema, tenderness, and mild muscle spasm, without noticeable loss of function. A first-
degree sprain is caused by tearing of few ligamentous fibers and is manifested by mild edema,
local tenderness, and pain that is elicited when the joint is moved, but there is no joint instability.
A second-degree sprain involves tearing of nerve fibers and results in increased edema,
tenderness, pain with motion, joint instability, and partial loss of normal joint function.
4. The nurse preparing the patient who has sustained a sprain of the left ankle for discharge from
the emergency room to home correctly instructs the patient to:
, A) Apply heat for the first 24 to 48 hours after injury. B) Maintain the ankle in a dependent
position.
C) Exercise hourly by performing rotation exercises of the ankle. D) Apply an elastic
compression bandage to the ankle.
Ans: D
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 2
Patient Needs: D-3
Feedback: Treatment of a sprain consists of resting and elevating the affected part, applying cold,
and using a compression bandage. After the acute inflammatory stage (usually 24 to 48 hours
after injury), heat may be applied intermittently.
5. The nurse caring for a patient with an open fracture of the radius is developing a care plan for
the patient. The nurse will assign priority to which of the following nursing diagnoses?
A) Risk for infection
B) Risk for activity intolerance
C) Risk for imbalanced nutrition, less than body requirements
D) Risk for powerlessness
Ans: A
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
Patient Needs: D-3
