ATI Care of Patients with Musculoskeletal Trauma, Questions and Answers with Explanations, 100% Correct, Download to Score A

Test Bank

MULTIPLE CHOICE

1. A client has a fracture and is being treated with skeletal traction. Which assessment causes the nurse to take immediate action?

a.            The client’s blood pressure is 130/86 mm Hg.

b.            The traction weights are resting on the floor.

c.             Slight oozing of clear fluid is noted at the pin site.

d.            Capillary refill of the extremity is less than 3 seconds.

ANS: B

The immediate action of the nurse should be to reapply the weights to give traction to the fracture. The health care provider must be notified that the weights were lying on the floor, and the client should be realigned in bed. Slight oozing of clear fluid is normal as is the capillary refill time. The client’s blood pressure is slightly elevated; this could be related to pain and muscle spasms resulting from lack of pressure to reduce the fracture.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Establishing Priorities) MSC: Integrated Process: Nursing Process (Assessment)

2. A client has been diagnosed with carpal tunnel syndrome. Which intervention does the nurse question in the treatment of this injury?

a.            Ibuprofen 600 mg three times a day with meals

b.            Weekly injections of a corticosteroid by the physician

c.             Morphine 30 mg to be taken orally every 4 hours

d.            Use of a hand brace or splint during the day

ANS: C

The client with carpal tunnel syndrome can be treated nonsurgically by administration of oral NSAIDs and corticosteroid injections. Most clients find relief with taking these medications and the use of a hand brace or splint to immobilize the wrist. The use of opioids such as morphine should not be necessary. NSAIDs and corticosteroids decrease inflammation and pain.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Illness Management) MSC: Integrated Process: Nursing Process (Implementation)

3. The nurse is caring for a client with a fractured femur. Which factor in the client’s history may impede healing of the fracture?

a.            A sedentary lifestyle

b.            A history of smoking

c.             Oral contraceptive use

d.            Paget’s disease

ANS: D

Paget’s disease and bone cancer can cause pathologic fractures such as a fractured femur that do not achieve total healing. The other factors do not impede healing but may cause other health risks.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1148

TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Assessment)

4. A client who has sustained a crush injury to the right lower leg reports numbness and tingling of the affected extremity. The skin of the right leg appears pale. Which is the nurse’s first intervention?

a.            Assess pedal pulses.

b.            Apply oxygen by nasal cannula.

c.             Increase the IV flow rate.

d.            Document the finding.

ANS: A

The symptoms represent early warning of acute compartment syndrome. In acute compartment syndrome, sensory deficits such as paresthesias precede changes in vascular or motor signs. If the nurse finds a decrease in pedal pulses, the health care provider should be notified as soon as possible.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—System-Specific Assessments) MSC: Integrated Process: Nursing Process (Assessment)

5. While assessing an older adult client admitted 2 days ago with a fractured hip, the nurse notes that the client is confused, tachypneic, and restless. Which is the nurse’s first action?

a.            Administer oxygen via nasal cannula.

b.            Apply restraints and ask for a sitter.

c.             Slow the IV flow rate.

d.            Discontinue the pain medication.

ANS: A

The client is at high risk for a fat embolism and has some of the clinical manifestations of altered mental status and dyspnea. Although this is a life-threatening emergency, the nurse should take the time to administer oxygen first and then notify the health care provider. Oxygen administration can reduce the risk for cerebral damage from hypoxia. The nurse would not restrain a client who is confused without further assessment and orders. Pain medication most likely would not cause the client to be restless. The IV rate is not related.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Establishing Priorities)

MSC: Integrated Process: Nursing Process (Implementation)

6. The nurse is caring for several clients with fractures. Which client does the nurse consider at highest risk for developing deep vein thrombosis?

a.            Middle-aged woman with a fractured ankle taking aspirin for rheumatoid arthritis

b.            Young adult male athlete with a fractured clavicle

c.             Female with type 2 diabetes with fractured ribs

d.            Older man who smokes and has a fractured pelvis

ANS: D

Deep vein thrombosis (DVT) as a complication with bone fractures occurs more often when fractures are sustained in the lower extremities and the client has additional risk factors for thrombus formation. Other risk factors include obesity, smoking, oral contraceptives, previous thrombus events, advanced age, venous stasis, and heart disease. The other clients do not have risk factors for DVT.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Analysis)

7. The nurse is rounding on assigned orthopedic clients. The client with which type of fracture requires immediate interventions to prevent infection?

a.            Fractured clavicle

b.            Open fracture of the tibia

c.             Simple fracture of the wrist

d.            Compression fracture of a vertebra

ANS: B

Bone infection or osteomyelitis is most common in clients with an open fracture because skin integrity is lost and organisms gain access easily. The nurse will remind all those who come into contact with the client to use good handwashing and will observe the wound daily for signs of infection. The other clients do not have extra risk factors for infection.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Analysis)

8. The nurse is performing an assessment on a client admitted with a fractured left humerus. When the client moves the extremity, the nurse notes the presence of a grating sound. Which is the nurse’s best intervention?

a.            Immobilize the arm.

b.            Perform range of motion.

c.             Monitor for other signs of infection.

d.            Administer steroids.

ANS: A

The grating sound heard when the affected part is moved is known as crepitation. This sound is created by bone fragments. Because bone fragments may be present, the nurse should immobilize the client’s arm and tell him or her not to move the arm. The nurse should not move the extremity for range of motion. The grating sound does not indicate infection. Steroids would not be indicated.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Establishing Priorities) MSC: Integrated Process: Nursing Process (Analysis)