Lewis Chapter 62: Musculoskeletal Trauma Quiz

Questions and Answers

What should the nurse know about the involvement of bone cells in bone remodeling?

Osteons create a dense bone structure.

Osteocytes are mature bone cells.

Osteoblasts deposit new bone. (correct)

Osteoclasts add canaliculi.

Which individual is most at risk to develop osteomyelitis caused by Staphylococcus aureus?

68-year-old female with hypertension who had a knee arthroplasty 3 years ago

48-year-old male with muscular dystrophy and acute bronchitis

32-year-old male with type 1 diabetes mellitus and a stage IV pressure ulcer (correct)

22-year-old female with gonorrhea who is an IV drug user

It is important for the nurse to follow up on which statement?

The patient who had a spinal fusion 12 hours ago has hypoactive bowel sounds and is not passing flatus.

The patient who had spinal surgery 3 hours ago is complaining of a headache and has clear drainage on the dressing. (correct)

The patient who had a laminectomy 24 hours ago is using patient-controlled analgesia with morphine for pain management.

The patient who had cervical spine surgery 2 days ago wants to wear her soft cervical collar when out of bed.

What is a priority laboratory assessment to make before the administration of ibandronate?

Serum phosphate Signup and view all the answers

Which assessment finding would indicate the possible presence of osteoporosis in a 61-year-old female?

A measurable loss of height Signup and view all the answers

What should the nurse explain about osteoporosis management?

Even with a family history of osteoporosis, calcium loss can be slowed by increased calcium intake and exercise. Signup and view all the answers

Which highest-calcium meal should a patient with osteoporosis choose?

A sardine (3 oz) sandwich on whole wheat bread, fruit yogurt, and skim milk Signup and view all the answers

Which symptom will the nurse most likely find in a patient with osteomyelitis of the tibia?

Localized pain and warmth Signup and view all the answers

How will acute osteomyelitis be treated?

IV antibiotics are usually required for several weeks. Signup and view all the answers

What is the highest priority intervention for a patient on bed rest with osteomyelitis?

Perform frequent position changes and range-of-motion exercises. Signup and view all the answers

Which nursing intervention is most appropriate for turning a patient following spinal surgery?

Placing a pillow between the patient's legs and turning the body as a unit. Signup and view all the answers

Why are antibiotic beads used in the treatment of osteomyelitis?

The beads are an adjunct to debridement and oral and IV antibiotics for deep infections. Signup and view all the answers

What symptom following spinal fusion should the nurse report to the physician?

The patient is unable to move the lower extremities. Signup and view all the answers

Which nursing intervention will be included in the plan of care for a patient with a proximal humerus fracture in a left-sided long-arm cast?

Assess the left axilla and change absorbent dressings as needed. Signup and view all the answers

Which patient action requires rapid intervention by the nurse after hip replacement surgery using the posterior approach?

The patient leans over to pull shoes and socks on. Signup and view all the answers

What action should the nurse take first for a patient with sudden onset shortness of breath after a hip fracture?

Administer the prescribed PRN oxygen at 4 L/min. Signup and view all the answers

Which finding is most important for the nurse to communicate to the health care provider after a fall?

The right arm appears shorter than the left. Signup and view all the answers

Which nursing action can be delegated to experienced nursing assistive personnel (NAP) when planning care for a patient who has had hip replacement surgery?

Reposition the patient every 1 to 2 hours. Signup and view all the answers

What should the initial nursing action be for a patient with possible left lower leg fractures?

Check the popliteal, dorsalis pedis, and posterior tibial pulses. Signup and view all the answers

Which priority nursing diagnosis should be developed for a patient with open reduction and internal fixation (ORIF) of a displaced fracture of the tibia?

Risk for infection related to disruption of skin integrity. Signup and view all the answers

Which action should the nurse take first when a patient with a fractured pelvis develops acute onset confusion?

Assess the oxygen saturation. Signup and view all the answers

Which information regarding a left femur fracture should be reported to the health care provider?

Prolonged capillary refill of the left foot. Signup and view all the answers

Before assisting a patient with ambulation the day after a total hip replacement, which action is most important for the nurse?

Administer the ordered oral opioid pain medication. Signup and view all the answers

In caring for a patient with left leg fractures after a motor vehicle accident, in what order will the nurse take these actions: obtain x-rays, check pedal pulses, assess lung sounds, take blood pressure, apply splint to the leg, administer tetanus prophylaxis.

C, D, B, E, A, F Signup and view all the answers

What should the nurse teach a patient who has lost 1 inch in height over the past 2 years?

Dual-energy x-ray absorptiometry (DXA). Signup and view all the answers

Which health history information about a 67-year-old woman alerts the nurse to assess the musculoskeletal system more closely?

The patient's mother became shorter with aging. Signup and view all the answers

Which medication poses a concern for a patient's musculoskeletal status?

The patient has severe asthma and requires frequent therapy with oral corticosteroids. Signup and view all the answers

What should a nurse plan before a 72-year-old patient scheduled for DXA testing?

Explain the procedure. Signup and view all the answers

Which information indicates that a nurse should consult with a health care provider before scheduling an MRI?

The patient has a pacemaker. Signup and view all the answers

What task can the nurse delegate to unlicensed assistive personnel (UAP) in the orthopedic clinic?

Obtain blood sample for uric acid from a patient with gout. Signup and view all the answers

What is most important for the nurse to assess in a 63-year-old woman taking prednisone after a kidney transplant?

Back or neck pain. Signup and view all the answers

Which statement indicates a 57-year-old postmenopausal woman understands the DXA procedure?

This procedure will not cause any pain or discomfort. Signup and view all the answers

What are the bone cells that function in the resorption of bone tissue called?

Osteoclasts. Signup and view all the answers

While obtaining subjective assessment data related to the musculoskeletal system, which medical problem should the nurse especially ask about?

Diabetes mellitus. Signup and view all the answers

After administering a radioisotope in a patient with cellulitis and probable osteomyelitis, when should the bone scan be scheduled?

11:00 AM. Signup and view all the answers

What should the nurse teach a patient about bone scan procedures?

The patient will be asked to drink increased fluids after the procedure. Signup and view all the answers

Musculoskeletal assessment is crucial for patients undergoing what type of long-term therapy?

Corticosteroids. Signup and view all the answers

What should the nurse document for a patient with rheumatoid arthritis experiencing knee stiffness and joint fixation?

Ankylosis. Signup and view all the answers

What is the best approach to assess range of motion (ROM) in an 81-year-old female patient with decreasing mobility?

Observe the patient's unassisted ROM in the affected leg. Signup and view all the answers

While completing an admission history for a 73-year-old man with osteoarthritis admitted for knee arthroplasty, what response should the nurse expect from the patient regarding the reason for admission?

Debilitating joint pain Signup and view all the answers

What should the nurse assess for in a patient with osteoarthritis who is about to undergo total knee arthroplasty?

Left knee infection Signup and view all the answers

What would be an appropriate nursing intervention for a patient following left total knee replacement who has impaired physical mobility due to decreased muscle strength?

Encourage isometric quadriceps-setting exercises at least qid. Signup and view all the answers

What should the nurse include in the care of the affected leg of a 76-year-old man who has undergone left knee arthroplasty?

Progressive leg exercises to obtain 90-degree flexion Signup and view all the answers

What action should the nurse take to protect the knee joint of a patient who underwent left total knee arthroplasty and has an order to be 'up in chair today before noon'?

Put on a knee immobilizer before moving the patient out of bed and keep the surgical leg elevated while sitting. Signup and view all the answers

What statement by an 80-year-old male patient who underwent right total hip arthroplasty indicates the need for further instruction?

Maintain hip in adduction and internal rotation. Signup and view all the answers

What is the best rationale for not allowing a 21-year-old male patient with a long leg cast to use crutches?

Excess edema and other problems are prevented when the leg is elevated for 24 hours. Signup and view all the answers

What should the nurse suspect if a patient with a tibial fracture and a cast presents pulseless, pale, cool feet and reports numbness?

Compartment syndrome Signup and view all the answers

When counseling an older patient about ways to prevent fractures, which information will the nurse include?

Buy shoes that provide good support and are comfortable to wear. Signup and view all the answers

When a patient with a cast in place after fracturing the radius asks when the cast can be removed, what should the nurse instruct?

For at least 3 weeks. Signup and view all the answers

What is the best action for a nurse assessing pressure areas on a patient with Buck's traction?

Have the patient lift the buttocks by bending and pushing with the left leg. Signup and view all the answers

After applying a hip spica cast on a patient with a left femur fracture, which nursing intervention will be included in the care plan?

Ask the patient about any abdominal discomfort or nausea. Signup and view all the answers

What should the nurse avoid doing until a long-arm plaster cast has completely dried for a fractured left radius?

Handle the cast with the palms of the hands. Signup and view all the answers

Which statement by a patient with a short-arm plaster cast indicates a good understanding of discharge teaching?

I will apply an ice pack to the cast over the fracture site for the next 24 hours. Signup and view all the answers

What should the nurse do when a patient complains of constant severe pain in the leg unrelieved by morphine after an ORIF of lower leg fractures?

Notify the health care provider. Signup and view all the answers

Which assessment finding should the nurse report after caring for a patient on bed rest following a complex pelvic fracture?

Abdominal distention is present and bowel tones are absent. Signup and view all the answers

What action will the nurse take in order to evaluate the effectiveness of Buck's traction for a patient with an intracapsular fracture of the left femur?

Ask about left hip pain level. Signup and view all the answers

What should the nurse include in the discharge teaching for a patient with multiple forearm fractures and a long-arm cast?

You will need to assess and clean the pin insertion sites daily. Signup and view all the answers

What action should the nurse take when assisting a patient who has had an ORIF of a hip fracture out of bed for the first time?

Check the postoperative orders for the patient's weight-bearing status. Signup and view all the answers

What information will the nurse include when teaching a patient who had a repair of a fractured mandible?

When and how to cut the immobilizing wires. Signup and view all the answers

What statement from a patient with ulnar drift caused by rheumatoid arthritis indicates a realistic expectation for surgery?

I will be able to use my fingers to grasp objects better. Signup and view all the answers

What should the nurse teach a patient with multiple forearm fractures and a long-arm cast to look out for?

Call the health care provider for increased swelling or numbness. Signup and view all the answers

Study Notes

Musculoskeletal Trauma and Orthopedic Surgery

Common reason for knee arthroplasty is debilitating joint pain, particularly in elderly patients with osteoarthritis.
Preoperative assessment prior to knee arthroplasty must check for infection; signs include redness, swelling, fever, and elevated white blood cell count.
Post-surgery, isometric quadriceps-setting exercises should be encouraged to enhance recovery and mobility after total knee replacement.
Progressive leg exercises are necessary to achieve at least 90-degree flexion post-knee arthroplasty for rehabilitation.
A knee immobilizer is vital during initial movements post-surgery to safeguard the surgical site and prevent instability.
After hip arthroplasty, patients must avoid crossing legs and maintaining adduction/internal rotation to prevent dislocation.
New long leg casts require elevation above heart level for the first 24 hours to reduce edema and complications like compartment syndrome.
Signs of compartment syndrome include the six Ps: paresthesia, pallor, pulselessness, pain, pressure, and paralysis; immediate intervention is crucial.
For fracture prevention in older adults, using supportive, comfortable shoes and removing tripping hazards, like scatter rugs, is essential.
Casts typically remain on for at least three weeks, as ossification doesn't start until this period after bone injury.
Buck's traction is used to immobilize fractures; care involves monitoring for pressure areas and avoiding changes that disrupt alignment.
Patients with external fixation devices need daily cleaning of pin sites to prevent infection; these devices allow mobility.
Evaluating Buck's traction effectiveness is best done by assessing pain levels; muscle spasms and dislocations are less of a concern.
Understanding discharge teaching is critical, especially regarding maintaining immobilization sequences and managing discomfort post-surgery.
Patients undergoing arthroplasty should expect to regain function in their hands, though they will need to continue therapy for strength and flexibility.
Awareness about cast care includes avoiding wetness and using appropriate pain management strategies post-injury.
Hip replacement surgeries using posterior approaches require careful monitoring of patient movement to prevent dislocation.
Sudden shortness of breath and tachypnea after hip fracture surgery could indicate serious complications such as pulmonary embolism; prompt assessment and intervention are necessary.### Pulmonary Embolus Symptoms
Clinical manifestations indicate a possible pulmonary embolus.
Prioritize ensuring adequate oxygenation before notifying healthcare provider.
Pulse oximetry and assessment for fat embolus or VTE are important after initiating oxygen therapy.

Fall and Arm Injury

Shortening of the arm post-fall suggests possible dislocation, an orthopedic emergency.
Other findings like bruising, pain, and decreased range of motion are significant but do not require immediate intervention.

Hip Replacement Care

Repositioning patients every 1 to 2 hours can be delegated to nursing assistive personnel (NAP).
Teaching exercises and assessing pain or skin irritation are RN responsibilities.

Fracture Patient Care

Assess neurovascular status (pulses) first before other actions in a suspected leg fracture.
Splinting and elevating the leg come after assessing vascular status.

ORIF Postoperative Care

Risk for infection due to skin integrity disruption is the primary nursing diagnosis following tibia ORIF.

Acute Confusion After Pelvic Fracture

Acute confusion may indicate a fat embolus; oxygen saturation should be assessed immediately.

Femur Fracture Report

Prolonged capillary refill suggests potential arterial damage or compartment syndrome; this finding requires immediate reporting.

Total Hip Replacement Ambulation

Administer pain medication prior to ambulation to ensure patient comfort during mobility activities.

Action Order for Accident Victim

Ensure airway, breathing, and circulation (ABCs) are intact before assessing leg injury and immobilization.
evaluations should precede x-ray referrals.

Osteoporosis Screening

Loss of height over two years suggests possible osteoporosis; DXA scanning is warranted.

Focused Assessment Indicators

Family history of height loss prompts focused musculoskeletal assessments for osteoporosis.

Medication Concerns for Musculoskeletal Health

Long-term corticosteroid use is a major risk factor for osteoporosis and related complications.

Bone Density Testing and Patient Understanding

DXA tests are painless and focus on spinal and femoral bone density; they require no sedatives or IV contrasts.

Bone Remodeling Knowledge

Osteoclasts breakdown bone tissue, while osteoblasts build new bone.

Assessment of Medical History

Inquiry about diabetes is critical as it impacts the musculoskeletal system.

Timing for Bone Scan Procedure

A bone scan should occur 2 hours post-radioisotope administration.

Patient Education on Bone Scans

Increased fluid intake post-scan is necessary to aid isotope excretion.

Musculoskeletal Assessment Relevance

Long-term corticosteroid therapy necessitates thorough musculoskeletal evaluations.

Joint Fixation Documentation

Ankylosis indicates joint stiffness or fixation.

Range of Motion Assessment

Observing a patient's unassisted ROM is the best method to assess mobility, especially in older adults.

Cell Types in Bone Remodeling

Osteoblasts are responsible for depositing new bone during remodeling.

Osteomyelitis Risk Factors

Patients with diabetes and pressure ulcers are at significant risk for Staphylococcus aureus osteomyelitis.

Post-Surgical Symptom Monitoring

Clear drainage and severe headache post-spinal surgery may indicate CSF leakage, requiring immediate intervention.

Ibandronate Laboratory Assessment

Serum phosphate is the crucial laboratory assessment before administering ibandronate for osteoporosis treatment.

Osteoporosis Indicators in Screening

A measurable loss of height in an older female suggests potential osteoporosis presence.### Unstable Wide-Gait Ambulation and Osteoporosis
Measurable loss of height and kyphosis are signs of osteoporosis, where bone resorption exceeds deposition.
Bowed legs, caused by rickets or abnormal bone development, do not indicate osteoporosis.
Calcium and Vitamin D deficiencies are risk factors but do not confirm osteoporosis.

Patient Education on Osteoporosis

Family history does not prevent or slow osteoporosis; increased calcium intake and exercise can help.
Continuous low-dose corticosteroids hinder bone metabolism, making them ineffective in managing osteoporosis.
Estrogen therapy is not advisable due to linked risks of heart disease and certain cancers.

Dietary Considerations for Osteoporosis

The meal with the highest calcium content: sardine sandwich, fruit yogurt, and skim milk.
Other meals contain lower calcium levels, with many foods under 75 mg of calcium per 100 g.

Osteomyelitis Symptoms and Treatment

Osteomyelitis, an infection of bone, typically presents localized pain and warmth at the infection site.
Standard treatment for acute osteomyelitis includes several weeks of IV antibiotics, not just oral antibiotics.

Patient Management and Positioning

For patients on bed rest, priority interventions include frequent position changes and range-of-motion exercises to prevent lung complications and contractures.
In post-spinal surgery, turning the patient should involve placing a pillow between legs and moving the body as a unit to preserve spinal alignment.

Surgical Debridement and Antibiotic Beads

Antibiotic beads are used to deliver direct antibiotic treatment to infected sites and serve as an adjunct to debridement and systemic antibiotics.
These beads are vital in treating chronic osteomyelitis where vascularization is inadequate.

Monitoring After Spinal Fusion

Post-surgery, inability to move lower extremities is a critical symptom that should be reported immediately as it indicates potential neurological issues.
Regular assessments of mobility and sensation are essential in the postoperative care protocol following spinal fusion.

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Description

Test your knowledge on musculoskeletal trauma and orthopedic surgery concepts from Lewis Chapter 62. This quiz focuses on the assessment of a patient with osteoarthritis and the factors leading to knee arthroplasty. Dive into key considerations and clinical scenarios related to orthopedic care.