NUR 1172 CH 41, Prep U Module 1, Chapter 40
Musculoskeletal Care Modalities
1. The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday.
What type of pharmacologic therapy does the nurse anticipate administering to this client to
prevent complications related to the surgery?
a) Anticoagulation therapy
b) Antidysrhythmia therapy
c) Antianginal therapy
d) Antineoplastic therapy
Answer
Anticoagulation therapy
Explanation
Anticoagulation therapy and early ambulation are very important for clients who have knee or hip
replacement to prevent thrombus formation. The other therapy is not indicated solely for the
knee or hip arthroplasty.
2. The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a
fracture tibia. What should the nurse inform the client prior to the cast being removed?
a) The skin may be covered with a yellowish crust that will shed in a few days.
b) The leg will look as it did prior to the cast being applied.
c) The leg will look moist and will have small bumps that will go away in a few days.
d) The leg strength is enforced by the wearing of the cast.
Answer
The skin may be covered with a yellowish crust that will shed in a few days.
Explanation
Once the cast is off, the skin appears mottled and may be covered with a yellowish crust
,composed of accumulated body oil and dead skin. The client usually sheds this residue in a few
days. The leg will not look as it did prior to the cast but will regain the same shape and status as
the other leg. There should be no bumps underneath the cast. The leg may be weak and stiff for
some time after the cast is removed, not stronger.
3. A variety of complications can occur after a leg amputation. All of the following are
possibilities in the immediate postoperative period, except?
a) Hemorrhage
b) Osteomyelitis
c) Infection
d) Hematoma
Answer
Osteomyelitis
Explanation
Chronic osteomyelitis may occur after persistent infection in the late postoperative period.
Hematoma, hemorrhage, and infection are potential complications in the immediate
postoperative period.
4. A client is about to have a cast applied to his left arm. The nurse would alert the client
towhich of the following as the cast is applied?
a) Increased in pain in left arm
b) Sensation of warmth or heat with application
c) Arm being moved to various positions
d) Sensation of weakness
Answer
Sensation of warmth or heat with application
,Explanation
When a cast is applied, the client needs to be aware that he may feel a sensation of warmth or heat
due to the material being mixed with water. The client should not feel an increase in pain
duringthe application. The arm will be held in place to ensure proper alignment during the
application.The client should not feel weakness in the extremity. This is more commonly
experiences after a cast is removed.
5. A client's cast is removed. The client is worried because the skin appears mottled and is
covered with a yellowish crust. What advice should the nurse give the client to address the skin
problem?
a) Avoid exposure to direct sunlight.
b) Apply lotions and take warm baths or soaks.
c) Scrub the area vigorously to remove the crust.
d) Consult a skin specialist.
Answer
Apply lotions and take warm baths or soaks.
Explanation
The client should be advised to apply lotions and take warm baths or soaks. This will help in
softening the skin and removing debris. The client usually sheds this residue in a few days so the
client need not consult a skin specialist. It is not advisable
to scrub the area vigorously. The client need not avoid exposure to direct sunlight because the
area is not photosensitive.
6. Which of the following nursing actions would help prevent deep vein thrombosis in a patient
who has had an orthopedic surgery?
a) Instructing about exercise, as prescribed
b) Instructing about using patient-controlled analgesia, if prescribed
c) Applying cold packs
d) Applying antiembolism stockings
Answer
Applying antiembolism stockings
, Explanation
Applying antiembolism stockings helps prevent deep vein thrombosis (DVT) in a patient who is
immobilized due to orthopedic surgery. Regular administration of analgesics controls and
prevents escalation of pain while ROM exercises help in maintaining muscle strength and tone
and prevent contractions. On the other hand, cold packs are applied to help reduce swelling and
this does not prevent deep vein thrombosis.
7. A client is seen in the emergency department for an injury acquired from falling off of a
bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the
same area.The client asks the nurse why a splint is applied and not a cast. What is the best
explanation by the nurse?
a) "The splint is less expensive than the cast."
b) "You will be able to wear the splint longer than you would a cast."
c) "We will need to monitor the status of the laceration to be sure it does not get infected."
d) "The arm does not require the same immobilization that a leg fracture would."
Answer
"We will need to monitor the status of the laceration to be sure it does not get infected."
Explanation
A splint would be used when there is special skin treatment or observation that is required. The
arm fracture would require the same form of immobilization that a leg fracture does. The length
of time the splint can be worn is equal to that of a cast to immobilize the fracture. The cost of
the splint and cast would be similar.
8. A 12-year-old client fractured her right leg several weeks ago while skiing and is returning
to the orthopedist to have her cast removed.What would you expect the physician to prescribe as
further treatment?
a) Apply cold compresses to leg for swelling.
b) No options are correct.
c) Discontinue use of crutches.
d) Physical therapy
Answer
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