(Osborn) Chapter 56: Learning Outcomes (Number and Title)

[Osborn] chapter 56
Learning Outcomes [Number and Title ]

Learning Outcome 1
Describe the incidence, prevalence, and prevention strategies
Learning Outcome 2
Learning Outcome 3
Learning Outcome 4
Learning Outcome 5
Learning Outcome 6
for musculoskeletal trauma.

Explain the pathophysiological stages of bone healing.
Compare and contrast the various types of fractures and
methods for fracture treatment.
Apply nursing diagnoses and the nursing process to the care of
the patient with musculoskeletal trauma.
Discuss potential complications related to musculoskeletal
trauma.
Identify research implications for nursing practice in caring for
the musculoskeletally injured patient.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
1. The nurse is aware that which of the following personal characteristic increases a clients risk for
musculoskeletal injuries?
Select all that apply.
1.
2.
3.
4.
5.
Belongs to a weekend softball team

Has begun an exercise program to lose weight
Avoids dairy products since being diagnosed as lactose intolerant
Requires insulin to manage type 2 diabetes mellitus
Is allergic to cat dander
Correct Answer:
1. Belongs to a weekend softball team
2. Has begun an exercise program to lose weight
3. Avoids dairy products since being diagnosed as lactose intolerant
Rationale: Belongs to a weekend softball team. Engaging in sports activities increases ones risk
for musculoskeletal injuries. Has begun an exercise program to lose weight. Engaging in exercise
routines increases ones risk for musculoskeletal injuries. Avoids dairy products since being
diagnosed as lactose intolerant. Calcium deficiencies pose a risk for bone injury and impaired bone
healing. Requires insulin to manage type 2 diabetes mellitus. Insulin use would not pose an
increased risk. Is allergic to cat dander. An allergy to cat dander would not pose an increased risk.
Cognitive Level: Analysis
Nursing Process: Assessment
Client Need: Health Promotion and Maintenance
LO: 1
2. The nurse is discussing ways to reduce the risks for musculoskeletal trauma with a group of older adults. The nurse includes:

1.
2.
3.
4.
5.
Avoiding the use of throw rugs.

Wearing nonskid shoes.
Using nightlights to illuminate paths to the bathroom and kitchen.
Installing handrails for assistance in entering and exiting bathtub.
Wearing an emergency alert device.
Correct Answer:
1. Avoiding the use of throw rugs.
2. Wearing nonskid shoes.
3. Using nightlights to illuminate paths to the bathroom and kitchen.
4. Installing handrails for assistance in entering and exiting bathtub.
Rationale: Avoiding the use of throw rugs. Throw rugs, cords, and other objects that impinge on
traffic areas increase the risk of falls at home for older adults. Wearing nonskid shoes. Improper
footwear increases the risk of falls at home for older adults. Using nightlights to illuminate paths
to the bathroom and kitchen. Risk of falling can be decreased by the use of appropriate lighting.
Installing handrails for assistance in entering and exiting bathtub. Risk of falling can be
decreased by the availability of handrails for both steps and in the bathroom. Wearing an
emergency alert device. Wearing an emergency alert device is effective in securing help if a fall
injury occurs, but does not reduce the risk of actually falling.
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 1
3. The nurse is aware that the older adult is at increased risk for musculoskeletal injuries as a result
of musculoskeletal changes associated with aging such as:
1.
2.
3.
4.
5.
Decreased bone mass.

Chronic illness and impaired healing.
Decreased range of motion.
Increased calcium reabsorption.
Vertebrae elongation.
Correct Answer:
1. Decreased bone mass.
2. Chronic illness and impaired healing.
3. Decreased range of motion.
Rationale: Decreased bone mass. With aging, decreased bone mass and calcium absorption
contribute to bones that are thinner and weaker (osteoporosis). Chronic illness and impaired
healing. The nurse should be aware of specific gerontological considerations such as chronic illness
and impaired healing. Decreased range of motion. Range of motion declines with age, resulting in a
risk for injury and falls. Muscle fibers atrophy, leading to loss of muscle mass, strength, and agility.
Increased calcium reabsorption. Increased calcium absorption and is not normally seen in the
older client. Vertebrae elongation. Vertebrae elongation is not normally seen in the older client.
Client Need: Health Promotion and Maintenance
LO: 1
4. A client who has been casted for a fracture of the left ulna bone asks the nurse when the cast will
come off. The nurses response is based on the knowledge that this will occur when:
1. The x-ray of the fractured bone shows that the ends are well joined.
2. A cartilage collar can be clearly felt at the site of the original break.
3. A predetermined amount of time has passed; the time is determined by the severity of the
break.
4. The remodeling phase of the bone healing process has been completed, allowing for
application of mechanical stress.
Correct Answer: The x-ray of the fractured bone shows that the ends are well joined.
Rationale: Ossification is the final laying down of bone after the fracture has been bridged and the
fragments are united. Mature bone replaces the callus, and the fracture site feels firm and appears
united on radiograph. It is at this point that a cast may be removed. During cellular proliferation and
callus formation, a cartilage collar is evident around the fracture site, but this does not signify that
the bone has healed sufficiently to remove the cast. While the amount of time a fracture requires
casting varies, the severity of the fracture is only one factor that is considered. Remodeling of the
bone occurs after the cast is removed.
Cognitive Level: Application
Client Need: Physiological Integrity
LO: 2
5. A client has dislocated his hip as a result of a fall. The nurse recognizes that the primary need to
quickly and effectively return the femoral head to its normal position is to:
1. Preserve blood flow to the head of the femur.
2. Eliminate the severe pain the client is experiencing.
3. Minimize the damage being caused to affected ligaments.
4. Avoid damage to nerves located in the affected area.
Correct Answer: Preserve blood flow to the head of the femur.
Rationale: A dislocation is a displacement of a bone from its normal position in a joint. While the
dislocation requires reduction as soon as possible to reduce pain and avoid ligament, vascular, and/or
nerve damage, the primary concern is interference with blood supply to the femoral head. This can
lead to severe complications such as avascular necrosis (AVN), in which the bone tissue dies due to a
temporary or permanent loss of blood supply to the bone. While important, the other manifestations
of the dislocation do not have priority over interrupted blood flow.
Nursing Process: Planning
LO: 2
6. The nurse explains to a client who is having a cast removed that the remodeling phase of fracture
healing involves the:
1.
2.
3.
4.
5.
Strengthening of the new bone at the site of the fracture.

Reabsorption of excess new bone at the site of the callus.
Prudent application of stress and weight to the affected bone.
Creation of the cartilage collar at the fracture sight.
Granulation of new bone tissue to form the connective bridge.
Correct Answer:
1. Strengthening of the new bone at the site of the fracture.
2. Reabsorption of excess new bone at the site of the callus.
3. Prudent application of stress and weight to the affected bone.
Rationale: Strengthening of the new bone at the site of the fracture. The remodeling process
involves reabsorption of the excess callus in the marrow space and the external aspect of the
fracture. The process is directed by mechanical stress and weight bearing, causing the bone to
become stronger in relation to its function. Reabsorption of excess new bone at the site of the
callus. The remodeling process involves reabsorption of the excess callus in the marrow space and
the external aspect of the fracture. Prudent application of stress and weight to the affected bone.
The remodeling process is directed by mechanical stress and weight bearing, causing the bone to
become stronger in relation to its function. Creation of the cartilage collar at the fracture sight. A
cartilage collar does form, but this does not occur in the remodeling phase. Granulation of new
bone tissue to form the connective bridge. Granulation is responsible for the formation of a
connective bridge, but this does not occur in the remodeling phase.
LO: 2
7. The nurse caring for a client who has experienced an open fracture of the humerus that is
classified as a Grade II is aware that the client:
1.
2.
3.
4.
5.
Will be scheduled for an inspection and debridement (I&D) procedure.

Has a moderately high risk for developing an infection.
Experienced some crushing of the bone.
Will require major vascular reconstruction.
Has an inside-out fracture.
Correct Answer:
1. Will be scheduled for an inspection and debridement (I&D) procedure.
2. Has a moderately high risk for developing an infection.
3. Experienced some crushing of the bone.
Rationale: Will be scheduled for an inspection and debridement (I&D) procedure. The wound
requires a procedure to wash out the contamination; this is commonly referred to as an inspection
and debridement (I&D). Has a moderately high risk for developing an infection. An important
concept is that all open fractures have the potential to be contaminated. thus increasing the risk of
infection. Experienced some crushing of the bone. A Grade II open fracture has a moderately
contaminated wound bed and contains a moderate amount of comminution (bone fragments). Will
require major vascular reconstruction. Major vascular reconstruction is not typically needed for
this injury. Has an inside-out fracture. A Grade I open fracture is sometimes referred to as an
inside-out fracture, while major vascular injury is classified a Grade IIIC.
LO: 3
8. An elderly client is admitted with a diagnosis of a fractured right hip resulting from a fall in her home. The nurse is preparing to initiate the order for
the application of Bucks traction to the affected leg. Put the following actions in the proper order to accomplish the intervention:
1.
2.
3.
4.
5.
Assemble the traction device and attach to the foot of the bed.
Carefully attach the weight to hang freely at the foot of the bed.
Have an assistant stand at the foot of the bed holding traction in a straight line.
Secure the Bucks boot to the skin on the leg.
Place the Bucks boot around the lower leg.
1, 3, 5, 4, 2
3, 1, 2, 4, 5
1, 5, 4, 3, 2
2, 1, 5, 3, 4
Correct Answer: 1, 3, 5, 4, 2
Rationale: Application or adjusting Bucks traction is a two-person procedure that must be planned
step-by-step in order to prevent further injury and minimize client discomfort. First, set up the
traction at the foot of the bed. Then, have an assistant stand at the foot of the bed holding traction in
a straight line. The third step is to place the Bucks boot around the lower leg. Then, secure the
Bucks boot to the skin on the leg. The final step is to carefully attach the weight to hang at the foot
of the bed while the assistant holds straight traction.
LO: 3
9. The nurse caring for a client whose fractured left femur was surgically managed with an
intramedullary (I-M) rodding shares with the clients family that the benefit of this type of fixation is
that it:
1.
2.
3.
4.
5.
Allows for early weight bearing.

Results in only minimal skin scarring.
Does not interfere with range of motion.
Facilitates direct visualization of the fracture.
Reduces the risk of a postsurgical fat embolus.
Correct Answer:
1. Allows for early weight bearing.
2. Results in only minimal skin scarring.
3. Does not interfere with range of motion.
Rationale: Allows for early weight bearing. Intramedullary (I-M) rodding refers to a method of
fracture fixation that entails sliding a metal rod down the medullary canal of a long bone. This form
of fixation allows for early weight bearing because it shares the load and leaves joints free to move.
Results in only minimal skin scarring. The benefits of this fixation method include small surgical
scars in less obvious places than with other methods. Does not interfere with range of motion. The
benefits of this fixation method include less interference with range of motion. Facilitates direct
visualization of the fracture. Open reduction methods allow for direct visualization of the actual
fracture. Reduces the risk of a postsurgical fat embolus. There is a slight increased risk of fat
embolism with this method.
LO: 3
10. An elderly woman admitted to the orthopedic unit following a fall that resulted in a fractured left
hip is placed in Bucks traction. The nurse includes which of the following interventions in the
clients preoperative plan of care?
1.
2.
3.
4.
Having someone hold the weights when moving the client up in bed
Providing pin site care every shift
Placing an abduction pillow between the clients legs
Turning the client to the unaffected side every 2 hours
Correct Answer: Having someone hold the weights when moving the client up in bed
Rationale: Bucks traction is used preoperatively to control muscle spasms, immobilize a fractured
hip, and maintain alignment of an extremity. Often, clients will scoot down toward the end of the
bed, and the weights will rest on the floor. To avoid injury and added pain, one person holds the
weights while the others use a lift sheet to reposition the client. Bucks traction is skin traction; no
skeletal pins are used. An abduction pillow is used postoperatively. A client cannot be turned with
this type of injury.
LO: 4
11. The nurse cannot palpate a clients pedal pulse following an open reduction internal fixation
(ORIF) procedure for a fractured tibia. Which action is the priority intervention?
1.
2.
3.
4.
Use a Doppler to find the pedal pulse.

Notify the surgeon of the problem.
Check the lower extremity for pallor.
Assess the clients pain rating.
Correct Answer: Use a Doppler to find the pedal pulse.

Rationale: To assess if circulation is present when the pulse is not palpable, the nurse should use a
Doppler. Notifying the surgeon should occur once all assessment data are collected; this would
include the presence of pallor and pain.
LO: 4
12. The nurse is caring for a client who recently experienced a traumatic amputation of the left leg
just below the knee due to a crushing injury at work while he was taking a smoke break. The nurse
shows an understanding of this clients condition when acknowledging that:
1.
2.
3.
4.
The clients report of pain in the area of the amputated foot is real.
Nerve regeneration to a reattached lower limb usually results in poor function.
Smoking is a significant risk factor for reattachment of limbs.
The recovery period for a limb reattachment would be similar to one for a surgical
amputation.
5. Crushing injuries are usually suitable for reattachment of the limb.
Correct Answer:
1. The clients report of pain in the area of the amputated foot is real.
2. Nerve regeneration to a reattached lower limb usually results in poor function.
3. Smoking is a significant risk factor for reattachment of limbs.
Rationale: The clients report of pain in the area of the amputated foot is real. The patient may
have bizarre sensations, such as feeling like the absent foot is cold or itchy. These are called phantom
limb sensations. Nerve regeneration to a reattached lower limb usually results in poor function.
Surgical reattachment of a severed limb is done only under certain circumstances because the
surgery is difficult. For adults, it is nearly impossible for nerves to regenerate in the lower extremity,
and the reattached limb may be painful and dysfunctional. Smoking is a significant risk factor for
reattachment of limbs. Only cleanly separated traumatic amputations in patients without significant
risk factors for impaired healing such as smoking are considered for reattachment. The recovery
period for a limb reattachment would be similar to one for a surgical amputation. Complete
amputation and prosthesis could allow a patient to return to normal activities in days to weeks,
whereas reconstruction of mangled limbs can span over years, with a huge psychological strain and
impact on function and occupation. Crushing injuries are usually suitable for reattachment of
the limb. Reattachment in crush-type amputations is not attempted due to the poor outcome.
LO: 4
13. There is concern that a client wearing a long leg cast is at risk for developing compartment
syndrome due to swelling. The nurse caring for the client shows the best understanding of the
complication and its specific treatment by gathering the following equipment:
1.
2.
3.
4.
Ace bandages, to wrap around the bi-valved cast.

Extra pillows, to elevate the casted extremity above the heart.
A Doppler, to aid in assessing the strength of peripheral pulses.
A percussion hammer, to physically assess reflexes for damage.
Correct Answer: Ace bandages, to wrap around the bi-valved cast.

Rationale: Compartment syndrome occurs when excess pressure in a limited space constricts the
structures within a compartment, reducing circulation to muscles and nerves. With increased edema,
this event threatens the viability of the clients limb and increases the risk of sepsis. Treatment can
include removing the cast entirely or bi-valving it (splitting it apart with a cast cutter) and securing
the two sides with ace wraps, tape, or Velcro straps. If the pressure is internal, a fasciotomy might be
necessary. Elevating the leg above the heart would compromise circulation. A Doppler could be used
to assess pulses, and a percussion hammer to check reflexes, but these are not therapeutic treatments
specific for compartment syndrome.
Nursing Process: Planning
Client Need: Physiologic Integrity
LO: 5
14. The day after surgery to replace a hip joint, the client states he is not ready to ambulate, and will
consider it tomorrow. The nurses initial action is to:
1.
2.
3.
4.
Explain the benefits of ambulation at this time to the client.

Ask the client why he is resistant to ambulating at this time.
Notify the surgeon of the clients noncompliance.
Document the clients refusal.
Correct Answer: Explain the benefits of ambulation at this time to the client.
Rationale: Educating the client about the rationale for ambulation at this time is the initial
intervention. It is premature to contact the health care provider. If the client continues to refuse to
ambulate, his reasons for doing so should be discussed. Documentation of the exchange is needed,
but should be done once the reason for the refusal is known.
LO: 5
15. An otherwise healthy client is scheduled to undergo a hip replacement to manage osteoarthritis.
When providing education concerning the procedure, the client asks if she should be concerned
about complications. The nurse best responds by replying:
1. Complications may occur with any surgical procedure, so lets discuss the common
ones.
2. Complications are variable, so its difficult to predict.
3. Your health care provider will be in to discuss complications with you just before the
surgery.
4. You are healthy and should have an uneventful recovery.
Correct Answer: Complications may occur with any surgical procedure, so lets discuss the
common ones.
Rationale: Complications can result from any surgery. The client should be aware of the most
common problems. Advising the client that complications are variable does not meet the question
posed to the nurse. Waiting until just before the surgery is too late to begin discussing complications.
The clients overall health does impact the incidence of complications, but it does not negate their
occurrence.
LO: 5
16. A group of nurses whose practice focuses of the care of clients with musculoskeletal injuries is
attempting to decide on a research topic that will have impact on the care of their particular clients.
The group decides to address the issue of:
1. The use of alternative methods to manage pain on the orthopedic unit.
2. The effectiveness of Bucks traction for the stabilization of closed tibia fractures.
3. The effects of casting versus splinting on the development of compartment syndrome.
4. The relationship between rhabdomyolysis and renal failure.
Correct Answer: Use of alternative methods to manage pain on the orthopedic unit.
Rationale: The need for additional research on the use of alternative methods of pain management
for musculoskeletal injuries has been identified as a need related to the nursing care of these clients;
the topic is also one that directly addresses a nursing responsibility. The remaining topics are all
medical in nature and not directly connected to nursing responsibilities.
LO: 6
17. A client with musculoskeletal pain from a leg injury asks the nurse what chiropractic techniques
are successful for his type of problem. The nurse responds:
1. There is currently very little research published on cases like yours.
2. I had some clients who are very happy with the chiropractic care theyve received.
3. I believe that traditional medicinal therapies have better results than chiropractic
therapies.
4. When the problem is pain, Im not sure that chiropractic techniques are research-based.
Correct Answer: There is currently very little research published on cases like yours.
Rationale: In chiropractic studies, there is a scarcity of higher-level research designs such as
randomized controlled trials. One study focused on patients with chronic musculoskeletal pain, and
compared the clinical outcomes of two chiropractic approaches for these patients. More research is
needed to arrive at definitive recommendations. Basing the response on the reports of a few clients is
not appropriate. The statements regarding traditional medicine and pain are based on personal
opinion, not research.
LO: 6
18. A committee of musculoskeletal care nurses has been meeting to formulate policy changes
regarding the proper method for providing pin site care to best minimize the clients risk for
infection. Based on the current research findings, the nurses come to the conclusion that:
1. Chlorhexidine 2 mg/mL solution is the cleanser of choice.
2. The critical period for infection control measures is up to 48 hours out from pin insertion.
3. Pins located in areas of considerable soft tissue are at least risk for infection.
4. Hydrogen peroxide is an acceptable choice of skin cleanser.
Correct Answer: Chlorhexidine 2 mg/mL solution is the cleanser of choice.
Rationale: Research supports that chlorhexidine 2 mg/mL solution appears be the most effective
cleansing solution for pin site care. Currently, the use of hydrogen peroxide is discouraged because it
may cause damage to the healthy tissue surrounding the pin; it has also been associated with
increased infection rates and the disruption of the skins normal flora. The critical period for
infection control is after the first 48 to 72 hours when drainage may be heavy; pin site care should be
done daily. Pins located in areas with considerable soft tissue should be considered at greater risk for
infection.
LO: 6

(Osborn) Chapter 56: Learning Outcomes (Number and Title)

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(Osborn) Chapter 56: Learning Outcomes (Number and Title)

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[Osborn] chapter 56

Learning Outcomes [Number and Title ]

for musculoskeletal trauma.

Belongs to a weekend softball team

Select all that apply.

Avoiding the use of throw rugs.

Decreased bone mass.

Strengthening of the new bone at the site of the fracture.

Will be scheduled for an inspection and debridement (I&D) procedure.

Allows for early weight bearing.

Use a Doppler to find the pedal pulse.

Correct Answer: Use a Doppler to find the pedal pulse.

Ace bandages, to wrap around the bi-valved cast.

Correct Answer: Ace bandages, to wrap around the bi-valved cast.

Explain the benefits of ambulation at this time to the client.

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