Musculoskeletal Trama and Orthopedic
Surgery Exam-Graded A
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." - ANSWER-
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.
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 patient's blood pressure. - ANSWER-ANS: A
The patient's 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.
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 - ANSWER-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.
, A 48-year-old patient with a comminuted fracture of the left femur has Buck's traction in
place while waiting for surgery. To assess for pressure areas on the patient's 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 patient's 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. -
ANSWER-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.
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. - ANSWER-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.
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." -
ANSWER-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.
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. - ANSWER-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.
Surgery Exam-Graded A
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." - ANSWER-
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.
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 patient's blood pressure. - ANSWER-ANS: A
The patient's 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.
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 - ANSWER-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.
, A 48-year-old patient with a comminuted fracture of the left femur has Buck's traction in
place while waiting for surgery. To assess for pressure areas on the patient's 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 patient's 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. -
ANSWER-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.
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. - ANSWER-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.
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." -
ANSWER-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.
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. - ANSWER-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.
