Connective Tissue Disorders: Chapter 32, Care of Patients with Musculoskeletal and Connective Tissue Disorders

Question 1 of 10

 Report content error

Which would be the priority nursing intervention for a suspected ankle fracture when the nurse observes notable displacement of a child’s ankle secondary to a fall from a swing set at a local park?

• • Placing an ice pack on the ankleIf an ice pack is present, the nurse would place it on the ankle while transporting the child to the emergency department.
• • Attempting to straighten the ankleThe nurse would not attempt to straighten the ankle.
• • Assessing for a pulse and sensation in the footThe nurse would not waste time assessing for a pulse and sensation because proper equipment and training is not available.
• Correct
  • Using available objects to immobilize the ankleThe nurse would quickly immobilize the ankle in its current position using available supplies and then help the patient to the nearest emergency department.

Question 2 of 10

 Report content error

Which nursing action is taken to prevent compartment syndrome in the patient who experiences a fractured ankle?

• • Provide the patient with adequate pain management.Adequate pain management is essential to managing any fracture. However, pain management does not prevent compartment syndrome.
• Correct
  • Elevate the ankle on pillows above the level of the heart.Elevating the ankle on pillows above the level of the heart prevents swelling in the extremity. Preventing swelling is key to reducing the risk for compartment syndrome.
• • Remove the patient’s external brace twice daily for 30 minutes.Removing the patient’s external brace twice daily for 30 minutes is not indicated and does not prevent compartment syndrome. The brace or cast should only be removed if swelling is severe enough to cause the cast or brace to be too tight and would be done under the supervision or direction of the health care provider.
• • Apply compression stockings to the unaffected extremity.Compression stockings are not indicated to prevent compartment syndrome. Compression stockings are used to prevent venous thrombosis rather than compression syndrome. Preventing swelling is key to reducing the risk for compartment syndrome.

Question 3 of 10

 Report content error

Which information would the nurse include when caring for the patient who experienced a strained hamstring? Select all that apply. One, some, or all responses may be correct.

• • You should arrange for the use of crutches for up to 2 weeks.Assistive devices are not typically needed for treatment of a strain.
• • The strain will be treated with a reduction using anesthesia.Strains are not treated with reduction. Dislocations are treated with reduction using anesthesia to return the joint to its usual placement.
• Correct
  • Heat may be applied 48 hours after the injury occurred.Heat may be applied after 48 hours for treatment of a strain.
• • A brace to immobilize the joint distal to the muscle will be needed.Immobilization of the joint distal to a strain is not indicated for treatment. Immobilization is needed in the case of a fracture, for example.
• Correct
  • Apply ice no more than 20 minutes every hour while awake.Ice can be used but for no more than 20 minutes each hour.

Question 4 of 10

 Report content error

Which statement describes the primary nursing care goal in treating a dislocated joint?

• • Recognize symptoms of infection early.Recognizing the symptoms of infection early are an important part of caring for the patient who has experienced a compound fracture, not for a dislocated joint. A dislocation does not involve a break in the skin. Nursing care management of a dislocated joint focuses on pain control and rest.
• • Establish an exercise program for strengthening.Establishing an exercise program for strengthening is not a treatment goal for dislocation. A meniscal injury, for example, would require an exercise program. Nursing care management of a dislocated joint focuses on pain control and rest.
• • Prevent hemorrhage and immobilize the joint.Preventing hemorrhage and immobilizing the joint are the emergency treatment goals for a fracture. Nursing care management of a dislocated joint focuses on pain control and rest.
• Correct
  • Carry out a pain management plan.Nursing care management of a dislocated joint focuses on pain control and rest.

Question 5 of 10

 Report content error

Which condition would the nurse suspect the patient has experienced when the patient’s history includes a job as a construction worker and playing baseball in high school, and the patient is unable to abduct the shoulder?

• • Dislocation of shoulderDislocation is associated with a traumatic event, an outside force pushing on the joint rather than long term overuse. The patient would complain of severe pain and may demonstrate an abnormal joint appearance.
• • Fractured humerusThe patient with a fractured humerus would complain of sharp pain in the arm and express a traumatic event such as a fall that occurred prior to the pain.
• Correct
  • Rotator cuff tearA rotator cuff tear is common in people who do repetitive activity, including throwing overhead such as in baseball. Construction workers often have repetitive activity as well. Symptoms of rotator cuff tear include the inability to abduct the shoulder.
• • Meniscal injuryThe meniscus is in the knee. Patients with symptoms of shoulder injury would not have a meniscal injury.

Question 6 of 10

 Report content error

Which condition would the nurse consider likely in the patient with diabetes and recently on antibiotic therapy who presents with pain in the back of the calf that occurred suddenly?

• Correct
  • Achilles tendon ruptureAn Achilles tendon rupture is associated with a sudden pain in the back of the calf or ankle. Risk factors include diabetes, arthritis, and having taken some antibiotics.
• • FractureA fracture is not as likely in this case because no trauma is indicated, and the patient has risk factors for an Achilles tendon rupture.
• • SprainA sprain is not as likely in this case, because no trauma is indicated, and the patient has risk factors for an Achilles tendon rupture.
• • Rotator cuff tearA rotator cuff tear occurs in the shoulder rather than the calf or leg.

Question 7 of 10

 Report content error

Which patient education will be included in the care of the patient diagnosed with bursitis of the knee? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Bursitis often occurs in knees and hips.Bursitis often occurs in joints that have excess use such as knees, shoulders, hips, and elbows.
• Correct
  • Ensure rest for the joint by reducing activity.Resting the joint is part of the recommended treatment for bursitis. Rest can reduce the overuse that has contributed to the inflammation.
• Correct
  • An over-the-counter anti-inflammatory may be used.Anti-inflammatory medications can be used, including over-the-counter options.
• Correct
  • Apply ice no more than 20 minutes every hour.Ice can be applied to the joint affected by bursitis. Ice should be applied no more than 20 minutes every hour.
• Correct
  • An elastic compression wrap can be used.If swelling is present, an elastic compression wrap can be used.
• Correct
  • Report to the provider if symptoms do not improve over time.If symptoms do not improve with time and treatment, the provider needs to be notified. An injection with cortisone may be indicated for further treatment.

Question 8 of 10

 Report content error

Which statement reflects the reason internal fixation is often necessary to treat simple fractures in older adults?

• • Older adults typically experience open fractures with significant soft tissue damage.Open fractures with soft tissue damage are typically treated with external fixation. Internal fixation is often used to address the brittle bones and reduced healing that occurs in older adults.
• • Older adults tend to develop infection in fractures that inhibit healing.If infection develops in a fracture that inhibits healing, external fixation is usually used. Internal fixation is often used to address the brittle bones and reduced healing that occurs in older adults.
• Correct
  • Older adults have reduced healing because of reduced calcium absorption.Older adults usually have bones that are less likely to heal effectively due to reduced calcium absorption and subsequent brittle nature. Proton pump inhibitors can contribute to the decrease in calcium absorption. Internal fixation is often used to address the brittle bones and reduced healing that occurs in older adults.
• • Older adults are unable to tolerate braces or casts for treatment.There is no indication that older adults are unable to tolerate braces or casts for treatment. Even with internal fixation, the joint will be immobilized for a time to allow for healing, requiring the use of a brace or cast.

Question 9 of 10

 Report content error

Which characteristic would the nurse recognize as the benefit to using a volar splint to manage a fracture?

• Correct
  • Allows for swelling early after the injuryA volar splint has a plaster of Paris portion for support that does not surround the injury. This configuration allows for adjustments needed related to swelling that can occur early in the treatment for the fracture.
• • Allows for early movement of the jointA fracture is immobilized until stable and early movement is not desired. Early movement may be desired in a strain or sprain, for example.
• • Allows for easy assessment of the skinA volar splint does not allow for easy assessment of the skin. A volar splint uses plaster of Paris to create a splint, but another material wraps around the injury.
• • Allows for quick adjustments to flexionThe volar splint does not allow for quick adjustments to flexion. A hinged brace will often have a dial that allows for quick adjustments to allow for progressive flexion and extension.

Question 10 of 10

 Report content error

Which indication would the nurse recognize as appropriate for a new warfarin prescription after a patient suffers a pelvic fracture?

• • Reduce the risk for a fat embolismWarfarin does not reduce the risk for a fat embolism. A fat embolism is caused by marrow fat entering a blood vessel.
• Correct
  • Reduce the risk for venous thrombosisWarfarin is an anticoagulant that reduces the risk for venous thrombosis. People who experience fractures, particularly fractures that cause immobility or need surgical repair, are at increased risk for venous thrombosis.
• • Manage osteomyelitisOsteomyelitis is managed and prevented with antibiotics such as Ancef.
• • Manage compartment syndromeCompartment syndrome is managed by reducing the pressure due to swelling of the injured area. This could include removing dressings, splitting a cast, or surgical fasciotomy.