Chapter 65: Nursing Management: Musculo-skeletal Trauma and Orthopedic
Surgery
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. The nurse is counselling a client about ways to prevent fractures. Which of the following
information should the nurse include?
a. Tack down throw 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. Throw 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: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
2. The nurse is caring for a client in the emergency department who is employed as a
checkout clerk in a grocery store and has a repetitive strain injury in the left elbow. Which
of the following treatment options should the nurse include in the teaching plan?
a. Surgical options
b. Elbow injections
c. Utilization of a left wrist splint
d. Modifications in arm movement
ANS: D
Treatment for a repetitive strain injury 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.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
3. The nurse is providing health-promotion teaching to a client whose job involves many
hours of word processing. Which of the following actions should the nurse include in the
client teaching plan?
a. Do stretching and warm-up exercises before starting work.
b. Wrap the wrists with a compression bandage every morning.
c. Use acetaminophen instead of nonsteroidal anti-inflammatory drugs (NSAIDs) for
wrist pain.
d. Obtain a keyboard pad to support the wrist while word processing.
ANS: D
, 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.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
4. The nurse is preparing a client for discharge from the emergency department with a
sprained wrist. Which of the following information should the nurse include?
a. Keep the wrist loosely wrapped with gauze.
b. Apply a heating pad to reduce muscle spasms.
c. Use pillows to elevate the arm above the heart.
d. Gently move the wrist through the range of motion.
ANS: C
Elevation of the arm will reduce the amount of swelling and pain. Compression bandages
are used to decrease swelling. For the first 24–48 hours, cold packs are used to reduce
swelling. The wrist should be rested and kept immobile to prevent further swelling or
injury.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
5. The nurse is caring for a client who is a baseball pitcher and had an arthroscopic repair of
a rotator cuff injury performed in same-day surgery. Which of the following information
should be included in the client’s postoperative teaching plan?
a. “You have an appointment with a physical therapist for tomorrow.”
b. “You can still play baseball but you will not be able to return to pitching.”
c. “The doctor will use the drop-arm test to determine the success of surgery.”
d. “Leave the shoulder immobilizer on for the first few days to minimize pain.”
ANS: A
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
client may be able to return to pitching after rehabilitation.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
6. The nurse is caring for a client who has a cast in place after fracturing the radius and the
client asks when the cast can be removed. Which of the following information related to
the length of time that the cast will need to remain in place should the nurse tell the client?
a. Several months
b. At least 3 weeks
c. Until swelling of the wrist has resolved
d. Until x-rays show complete bony union
ANS: B
Surgery
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. The nurse is counselling a client about ways to prevent fractures. Which of the following
information should the nurse include?
a. Tack down throw 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. Throw 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: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
2. The nurse is caring for a client in the emergency department who is employed as a
checkout clerk in a grocery store and has a repetitive strain injury in the left elbow. Which
of the following treatment options should the nurse include in the teaching plan?
a. Surgical options
b. Elbow injections
c. Utilization of a left wrist splint
d. Modifications in arm movement
ANS: D
Treatment for a repetitive strain injury 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.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
3. The nurse is providing health-promotion teaching to a client whose job involves many
hours of word processing. Which of the following actions should the nurse include in the
client teaching plan?
a. Do stretching and warm-up exercises before starting work.
b. Wrap the wrists with a compression bandage every morning.
c. Use acetaminophen instead of nonsteroidal anti-inflammatory drugs (NSAIDs) for
wrist pain.
d. Obtain a keyboard pad to support the wrist while word processing.
ANS: D
, 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.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
4. The nurse is preparing a client for discharge from the emergency department with a
sprained wrist. Which of the following information should the nurse include?
a. Keep the wrist loosely wrapped with gauze.
b. Apply a heating pad to reduce muscle spasms.
c. Use pillows to elevate the arm above the heart.
d. Gently move the wrist through the range of motion.
ANS: C
Elevation of the arm will reduce the amount of swelling and pain. Compression bandages
are used to decrease swelling. For the first 24–48 hours, cold packs are used to reduce
swelling. The wrist should be rested and kept immobile to prevent further swelling or
injury.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
5. The nurse is caring for a client who is a baseball pitcher and had an arthroscopic repair of
a rotator cuff injury performed in same-day surgery. Which of the following information
should be included in the client’s postoperative teaching plan?
a. “You have an appointment with a physical therapist for tomorrow.”
b. “You can still play baseball but you will not be able to return to pitching.”
c. “The doctor will use the drop-arm test to determine the success of surgery.”
d. “Leave the shoulder immobilizer on for the first few days to minimize pain.”
ANS: A
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
client may be able to return to pitching after rehabilitation.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
6. The nurse is caring for a client who has a cast in place after fracturing the radius and the
client asks when the cast can be removed. Which of the following information related to
the length of time that the cast will need to remain in place should the nurse tell the client?
a. Several months
b. At least 3 weeks
c. Until swelling of the wrist has resolved
d. Until x-rays show complete bony union
ANS: B
