Title: Quiz: Traumatic Disorders of the Musculoskeletal System
Course: PRN 0092 Practical Nursing II > Section: Nursing Care of Clients with Musculoskeletal Disorders

Q: The movement of an extremity away from the midline of the body is called
- abduction.
- adduction.
- flexion.
- extension.
A: abduction.
If right: Abduction is movement of an extremity away from the midline of the body.
If wrong: Abduction is movement of an extremity away from the midline of the body.

Q: The large, fan-shaped muscle that covers the anterior chest from the sternum to the proximal end of the humerus and acts on the joint of the shoulder to flex, adduct, and rotate is
- serratus anterior.
- intercostal.
- transversus abdominis.
- pectoralis major.
A: pectoralis major.
If right: Pectoralis major is the large, fan-shaped muscle that covers the anterior chest and is an adductor muscle, which will cause the shoulder to flex.
If wrong: Pectoralis major is the large, fan-shaped muscle that covers the anterior chest and is an adductor muscle, which will cause the shoulder to flex.

Q: A patient, age 79, fell at home and suffered an intracapsular fracture of his left hip. The orthopedic surgeon inserted a prosthetic implant for a bipolar hip replacement. The physician has instructed the nurse to turn him every 2 hours. The nurse understands that the correct nursing intervention is to keep the legs
- together so they don’t separate while turning.
- from rubbing together.
- abducted so the prosthesis does not become dislocated.
- abducted to prevent additional pain for the patient with turning.
A: abducted so the prosthesis does not become dislocated.
If right: Nursing interventions also involve postoperative maintenance of leg abduction by using an abduction splint for 7 to 10 days to prevent dislocation of the prosthesis.
If wrong: Nursing interventions also involve postoperative maintenance of leg abduction by using an abduction splint for 7 to 10 days to prevent dislocation of the prosthesis.

Q: A patient, age 24, has a compartment syndrome after a fracture of his radius and ulna. Nursing assessment will include careful observation for signs and symptoms of
- buccal petechiae.
- thromboembolism.
- Volkmann’s contracture.
- fat embolism.
A: Volkmann’s contracture.
If right: Volkmann’s contracture is a permanent contracture that can occur as a result of circulatory obstruction secondary to compartment syndrome.
If wrong: Volkmann’s contracture is a permanent contracture that can occur as a result of circulatory obstruction secondary to compartment syndrome.

Q: A patient fell 2 days ago; he has a compound fracture of his left tibia. The physician performed an open reduction with internal fixation (ORIF) to treat the fracture. An important nursing assessment for him would include
- hyperactive bowel sounds.
- elevated temperature and presence of erythema at incision site.
- ecchymosis and edema at incision site.
- complaints of activity intolerance.
A: elevated temperature and presence of erythema at incision site.
If right: Collection of objective data includes careful inspection of any wounds. The drainage is assessed for color, amount, and presence of odor. Vital signs are assessed for signs of infection (temperature elevation, tachycardia, and tachypnea).
If wrong: Collection of objective data includes careful inspection of any wounds. The drainage is assessed for color, amount, and presence of odor. Vital signs are assessed for signs of infection (temperature elevation, tachycardia, and tachypnea).

Q: A patient, age 24, is recovering from a fractured tibia. She has been wearing a leg cast for the past month to immobilize the fracture and promote proper alignment. She is being seen at the clinic for follow-up radiographic evaluation of the fracture. The physician tells her that he is hoping for good callus formation to have occurred. When she asks what callus formation is, the nurse tells her it is
- when blood vessels of the bone are compressed.
- a part of the bone healing process after a fracture when new bone is being formed over the fracture site.
- the formation of a clot over the fracture site.
- when the hematoma becomes organized and a fibrin meshwork is formed.
A: a part of the bone healing process after a fracture when new bone is being formed over the fracture site.
If right: Callus formation occurs when the osteoblasts continue to lay the network for bone build-up and osteoclasts destroy dead bone.
If wrong: Callus formation occurs when the osteoblasts continue to lay the network for bone build-up and osteoclasts destroy dead bone.

Q: A patient, age 24, had a traumatic amputation of his left foot in a motorcycle accident. He is receiving morphine by a patient-controlled analgesia (PCA) device. He complains of a burning sensation in his left foot. The nurse should explain that
- this is a phantom pain and that its cause is not clearly understood.
- this is not possible because his foot was amputated.
- his regular pain medication will relieve the pain.
- this phantom pain will disappear in about 1 week.
A: this is a phantom pain and that its cause is not clearly understood.
If right: Phantom pain (pain felt in the missing extremity as if it were still present) may occur and be frightening to the patient. Phantom pain occurs because the nerve tracts that register pain in the amputated area continued to send a message to the brain (this is normal).
If wrong: Phantom pain (pain felt in the missing extremity as if it were still present) may occur and be frightening to the patient. Phantom pain occurs because the nerve tracts that register pain in the amputated area continued to send a message to the brain (this is normal).

Q: A patient, age 28, has a fractured tibia and fibula. The nurse is performing an assessment of her extremities. The purpose of assessing capillary filling or performing a blanching test is to assess for adequate
- arterial peripheral circulation.
- cardiac output.
- venous peripheral circulation.
- nutritional deficiency.
A: arterial peripheral circulation.
If right: The blanching test measures the rate of capillary refill, which signals circulation status.
If wrong: The blanching test measures the rate of capillary refill, which signals circulation status.

Q: A patient has sustained a fractured femur in a car accident. The physician has stated concern about the possibility of a fat embolism. The patient’s wife asks the nurse about the cause of a fat embolism. The nurse’s most appropriate response would be
- “Arterial blood flow is interrupted at the site of injury.”
- “Floating fat sometimes causes problems.”
- “The break in the bone forces molecules of fat into the bloodstream.”
- “We don’t know the cause. We just know that it sometimes happens.”
A: “The break in the bone forces molecules of fat into the bloodstream.”
If right: Pulmonary fat embolism involves the embolization of fat tissue with platelets and circulation of free fatty acids within the pulmonary circulation.
If wrong: Pulmonary fat embolism involves the embolization of fat tissue with platelets and circulation of free fatty acids within the pulmonary circulation.

Q: The first priority nursing intervention for an impending fat embolism is to administer
- oxygen in a respiratory emergency.
- intravenous fluids in hypovolemic emergency.
- Lasix IV for fluid overload.
- blood therapy in a cardiac emergency.
A: oxygen in a respiratory emergency.
If right: Airway is always the first priority. If hypoxia is present, the physician will order the administration of oxygen. It is important for the nurse to check the liter flow of oxygen and educate patients and their families as to safety precautions necessary when oxygen is administered.
If wrong: Airway is always the first priority. If hypoxia is present, the physician will order the administration of oxygen. It is important for the nurse to check the liter flow of oxygen and educate patients and their families as to safety precautions necessary when oxygen is administered.

Q: A patient, age 68, has suffered an intertrochanteric fracture of the right hip. Before surgery, to provide support and comfort, an immobilizing device is applied. This is called a
- Thomas splint.
- Bryant’s traction.
- Russell’s traction
- Buck’s traction.
A: Buck’s traction.
If right: Buck’s traction is a form of traction used as a temporary measure to provide support and comfort to a fractured extremity until a more definite treatment is initiated.
If wrong: Buck’s traction is a form of traction used as a temporary measure to provide support and comfort to a fractured extremity until a more definite treatment is initiated.

Q: A patient, age 18, has multiple soft tissue injuries from a bicycle accident. Primary medical management for soft tissue injuries includes
- rest and heat to control edema.
- elevation and ice to control edema.
- immediate immobilization to halt pain.
- aspiration of excessive fluid.
A: elevation and ice to control edema.
If right: Contusions are the most common soft tissue injury. Most contusions are treated by applying ice bags or cold compresses.
If wrong: Contusions are the most common soft tissue injury. Most contusions are treated by applying ice bags or cold compresses.

Q: The patient is a 20-year-old who has suffered a compound fracture of the femur. The nurse would expect the physician to order ____ intramuscularly.
- tetanus toxoid
- morphine gluconate
- low-molecular–weight heparin
- calcium gluconate
A: tetanus toxoid
If right: Administration of tetanus toxoid is an additional medical measure for compound fracture of the femur.
If wrong: Administration of tetanus toxoid is an additional medical measure for compound fracture of the femur.

Q: A patient, age 72, has a left intertrochanteric fracture as a result of a fall. In planning ways to increase her safety, the nurse realizes it is most important to determine
- preexisting health conditions.
- nutritional status.
- psychosocial history.
- pain level.
A: preexisting health conditions.
If right: The patient’s medical and surgical history is significant, as well as any family history of bone disease. Although pain level, nutritional status, and psychosocial history are important, they are not the most important.
If wrong: The patient’s medical and surgical history is significant, as well as any family history of bone disease. Although pain level, nutritional status, and psychosocial history are important, they are not the most important.

Q: A patient has undergone a bipolar hip repair (hemiarthroplasty). She should be instructed to
- sit in whatever position is most comfortable.
- sit in a firm, straight-backed chair at a 90-degree angle.
- avoid crossing her legs.
- begin full weight-bearing as soon as tolerated.
A: avoid crossing her legs.
If right: Instructing the patient not to cross the legs is important because crossing the legs can adduct the affected extremity and dislocate the hip.
If wrong: Instructing the patient not to cross the legs is important because crossing the legs can adduct the affected extremity and dislocate the hip.

Q: A 28-year-old male patient has a fractured left humerus. He has a cast on his arm. The nurse observes pallor, coolness, and a decrease in capillary refill time to his left hand and fingers. These observations are likely to indicate
- compartment syndrome.
- early infection.
- hemorrhage.
- shock.
A: compartment syndrome.
If right: Collection of objective data involves assessment of the patient’s ability to flex the fingers or toes, coolness of the extremity, and absence of pulse in the affected extremity all of which indicate the impaired circulation symptomatic of compartment syndrome. Assessment of skin color for signs of pallor or cyanosis is made.
If wrong: Collection of objective data involves assessment of the patient’s ability to flex the fingers or toes, coolness of the extremity, and absence of pulse in the affected extremity all of which indicate the impaired circulation symptomatic of compartment syndrome. Assessment of skin color for signs of pallor or cyanosis is made.

Q: A patient, age 45, has had a left intramedullary rod placed into his left femur. He is presenting with signs and symptoms of postoperative shock. The recommended position for a person going into shock is
- semi-Fowler’s.
- supine.
- Fowler’s
- Trendelenburg.
A: supine.
If right: The patient should remain flat in bed. Avoid the Trendelenburg position because it pushes the abdominal organs against the diaphragm, affecting the lung and heart.
If wrong: The patient should remain flat in bed. Avoid the Trendelenburg position because it pushes the abdominal organs against the diaphragm, affecting the lung and heart.

Q: When caring for the patient who is in shock, the nurse should provide
- adequate oral fluids to replace blood loss.
- external heat to combat shivering.
- sedatives to decrease anxiety and apprehension.
- oxygen to support respiratory function.
A: oxygen to support respiratory function.
If right: Respiratory assistance may be given by administering oxygen. IV fluids are required for rapid access to blood volume. Shock causes altered level of consciousness and does not require medication to decrease anxiety or apprehension.
If wrong: Respiratory assistance may be given by administering oxygen. IV fluids are required for rapid access to blood volume. Shock causes altered level of consciousness and does not require medication to decrease anxiety or apprehension.

Q: The immediate medical management of any fracture is:
- Observe patient for signs of shock.
- Administer analgesics for pain.
- Splint and elevate the involved part.
- Apply heat to control pain.
A: Splint and elevate the involved part.
If right: Immediate management includes splinting and elevation of the involved part to prevent edema. After the immediate management, analgesic for pain, application of cold to prevent edema, and observing for signs of shock must be part of the plan of care.
If wrong: Immediate management includes splinting and elevation of the involved part to prevent edema. After the immediate management, analgesic for pain, application of cold to prevent edema, and observing for signs of shock must be part of the plan of care.

Q: A client with a newly applied plaster cast complains of unrelieved pain and paresthesia in the affected extremity.  The assessment by the nursee reveals diminished pulse, pallor, and increased pain on passive motion.  What must the nursee do first?
- Monitor the client for the next hour
- Administer an analgesic for pain
- Administer an anxiolytic
- Notify physician immediateley
A: Notify physician immediateley

Q: The nurse is preparing a client who sustained a hip fracture for discharge.  The nurse should teach the client to avoid which of the following groups of activities to prevent dislocation of the hip?
- Crossing legs, bending at hips, and sitting on low toilet seats
- Taking leisurely walks, low chair seats, and bending at hips
- Using a reacher device for applying shoes and socks, and sitting in chairs with arms
- All exercises, bedrest, and using raised toilet seats
A: Crossing legs, bending at hips, and sitting on low toilet seats

Q: A client with a recently applied plaster leg cast complains of unrelieved pain and paresthesia in the affected extremity.  The assessment by the nurse reveals diminished pulse, pallor, and increased pain on passive motion.  What must the nurse do first?
- Monitor client for the next hour
- Administer an analgesic for pain
- Administer an anxiolytic
- Notify physician immediately
A: Notify physician immediately

Q: The nurse is caring for a client who had open reduction and internal fixation (ORIF) of the right femur 4 days ago.  The client reports intense pain, swelling, tenderness, and warmth at the site; chills; malaise; and has a temperature of 102.2F.  The nurse concludes that this data is consistent with which of the following?
- Fat embolism
- Compartment syndrome
- Osteomyelitis
- Malunion of the bone
A: Osteomyelitis

Q: The nurse prepares a client for a bone scan.  What priority assessment should the nurse perform for this client?
- History of claustrophobia
- Presence of intravenous (IV) access
- Current vital signs
- Presence of metallic implants such as a pacemaker or aneurysm clips
A: Presence of intravenous (IV) access

Q: The nurse receives a client with a hip spica cast that is not completely dry.  When turning the client, the nurse uses the palms and not the fingertips.  The nurse chooses this technique for which of the following purposes?
- To speed dry the cast
- To decrease pain from moving
- To prevent damage to the cast
- To prevent swelling
A: To prevent damage to the cast