Chapter 36 Management of Patients With Musculoskeletal Disorders
1. A nurse is caring for a patient who has had a plaster arm cast applied. Immediately
postapplication, the nurse should provide what teaching to the patient?
A) The cast will feel cool to touch for the first 30 minutes.
B) The cast should be wrapped snuggly with a towel until the patient gets home.
C) The cast should be supported on a board while drying. D) The cast will only have full
strength when dry.
Ans: D
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 cast will exude
heat while it dries and should not be wrapped.
2. A patient broke his arm in a sports accident and required the application of a cast.
Shortly following application, the patient complained of an inability to straighten his fingers
and was subsequently diagnosed with Volkmann contracture. What pathophysiologic process
caused this complication?
A) Obstructed arterial blood flow to the forearm and hand
B) Simultaneous pressure on the ulnar and radial nerves C) Irritation of Merkel cells in
the patient's skin surfaces D) Uncontrolled muscle spasms in the patient's forearm Ans: A
Feedback:
Volkmann contracture occurs when arterial blood flow is restricted to the forearm and
hand and results in contractures of the fingers and wrist. It does not result from nerve
pressure, skin irritation, or spasms.
,3. A patient is admitted to the unit in traction for a fractured proximal femur and
requires traction prior to surgery. What is the most appropriate type of traction to apply to a
fractured proximal femur?
A) Russell's traction
B) Dunlop's traction
C) Buck's extension traction
D) Cervical head halter
Ans: C
Feedback:
Buck's extension is used for fractures of the proximal femur. Russell's traction is used
for lower leg fractures. Dunlop's traction is applied to the upper extremity for supracondylar
fractures of the elbow and humerus. Cervical head halters are used to stabilize the neck.
4. A nurse is caring for a patient who is in skeletal traction. To prevent the complication of
skin breakdown in a patient with skeletal traction, what action should be included in the plan
of care?
A) Apply occlusive dressings to the pin sites.
B) Encourage the patient to push up with the elbows when repositioning. C) Encourage
the patient to perform isometric exercises once a shift.
D) Assess the pin insertion site every 8 hours. Ans: D
Feedback:
The pin insertion site should be assessed every 8 hours for inflammation and infection.
Loose cover dressings should be applied to pin sites. The patient should be encouraged to use
the overhead trapeze to shift weight for repositioning. Isometric exercises should be done 10
times an hour while awake.
, 5. A nurse is caring for a patient who is postoperative day 1 right hip replacement. How
should the nurse position the patient?
A) Keep the patient's hips in abduction at all times.
B) Keep hips flexed at no less than 90 degrees. C) Elevate the head of the bed to high
Fowler's.
D) Seat the patient in a low chair as soon as possible. Ans: A
Feedback:
The hips should be kept in abduction by an abductor pillow. Hips should not be flexed
more than 90 degrees, and the head of bed should not be elevated more than 60 degrees. The
patient's hips should be higher than the knees; as such, high seat chairs should be used.
6. While assessing a patient who has had knee replacement surgery, the nurse notes
that the patient has developed a hematoma at the surgical site. The affected leg has a
decreased pedal pulse. What would be the priority nursing diagnosis for this patient? A)
Risk for Infection
B) Risk for Peripheral Neurovascular Dysfunction
C) Unilateral Neglect
D) Disturbed Kinesthetic Sensory Perception
Ans: B
Feedback:
The hematoma may cause an interruption of tissue perfusion, so the most appropriate nursing
diagnosis is Risk of Peripheral Neurovascular Dysfunction. There is also an associated risk for
1. A nurse is caring for a patient who has had a plaster arm cast applied. Immediately
postapplication, the nurse should provide what teaching to the patient?
A) The cast will feel cool to touch for the first 30 minutes.
B) The cast should be wrapped snuggly with a towel until the patient gets home.
C) The cast should be supported on a board while drying. D) The cast will only have full
strength when dry.
Ans: D
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 cast will exude
heat while it dries and should not be wrapped.
2. A patient broke his arm in a sports accident and required the application of a cast.
Shortly following application, the patient complained of an inability to straighten his fingers
and was subsequently diagnosed with Volkmann contracture. What pathophysiologic process
caused this complication?
A) Obstructed arterial blood flow to the forearm and hand
B) Simultaneous pressure on the ulnar and radial nerves C) Irritation of Merkel cells in
the patient's skin surfaces D) Uncontrolled muscle spasms in the patient's forearm Ans: A
Feedback:
Volkmann contracture occurs when arterial blood flow is restricted to the forearm and
hand and results in contractures of the fingers and wrist. It does not result from nerve
pressure, skin irritation, or spasms.
,3. A patient is admitted to the unit in traction for a fractured proximal femur and
requires traction prior to surgery. What is the most appropriate type of traction to apply to a
fractured proximal femur?
A) Russell's traction
B) Dunlop's traction
C) Buck's extension traction
D) Cervical head halter
Ans: C
Feedback:
Buck's extension is used for fractures of the proximal femur. Russell's traction is used
for lower leg fractures. Dunlop's traction is applied to the upper extremity for supracondylar
fractures of the elbow and humerus. Cervical head halters are used to stabilize the neck.
4. A nurse is caring for a patient who is in skeletal traction. To prevent the complication of
skin breakdown in a patient with skeletal traction, what action should be included in the plan
of care?
A) Apply occlusive dressings to the pin sites.
B) Encourage the patient to push up with the elbows when repositioning. C) Encourage
the patient to perform isometric exercises once a shift.
D) Assess the pin insertion site every 8 hours. Ans: D
Feedback:
The pin insertion site should be assessed every 8 hours for inflammation and infection.
Loose cover dressings should be applied to pin sites. The patient should be encouraged to use
the overhead trapeze to shift weight for repositioning. Isometric exercises should be done 10
times an hour while awake.
, 5. A nurse is caring for a patient who is postoperative day 1 right hip replacement. How
should the nurse position the patient?
A) Keep the patient's hips in abduction at all times.
B) Keep hips flexed at no less than 90 degrees. C) Elevate the head of the bed to high
Fowler's.
D) Seat the patient in a low chair as soon as possible. Ans: A
Feedback:
The hips should be kept in abduction by an abductor pillow. Hips should not be flexed
more than 90 degrees, and the head of bed should not be elevated more than 60 degrees. The
patient's hips should be higher than the knees; as such, high seat chairs should be used.
6. While assessing a patient who has had knee replacement surgery, the nurse notes
that the patient has developed a hematoma at the surgical site. The affected leg has a
decreased pedal pulse. What would be the priority nursing diagnosis for this patient? A)
Risk for Infection
B) Risk for Peripheral Neurovascular Dysfunction
C) Unilateral Neglect
D) Disturbed Kinesthetic Sensory Perception
Ans: B
Feedback:
The hematoma may cause an interruption of tissue perfusion, so the most appropriate nursing
diagnosis is Risk of Peripheral Neurovascular Dysfunction. There is also an associated risk for
