NCLEX RN Questions about Musculoskeletal Injuries (56-60)

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56. A client with a fractured right ankle has a short leg cast applied in the emergency department. During discharge teaching, the nurse provides which information to the client to prevent complications?

a) trim the rough edges of the cast after it is dry
b) weigh-bearing on the right leg is allowed once the cast feels dry
c) expect burning and tingling sensations under the cast for 3 to 4 days
d) keep the right ankle elevated above the heart level with pillows for 24 hours

57. An older adult female client with a fractured left tibia has a long leg cast and is using crutches to ambulate. In caring for the client, the nurse assesses for which sign or symptom that indicates a complication associated with crutch walking?

a) left leg discomfort
b) weak biceps brachii
c) triceps muscle spasms
d) forearm muscle weakness

58. A nurse is caring for a client with Buck's traction and is monitoring the client for complications of the traction. Which assessment finding indicates a complication?

a) weak pedal pulses
b) drainage at the pin sites
c) complaints of discomfort
d) warm toes with brisk capillary refill

59. A client has fallen and sustained a leg injury. Which question would the nurse ask the cleint to help determine if the injury caused a fracture?

a) is the pain a dull ache?
b) is the pain sharp and continuous?
c) does the discomfort feel like a cramp?
d) does the pain feel like the muscle was stretched?

60. The nurse is assessing the casted extremity of a client for signs of infection. Which of the following findings is indicative of infection?

a) dependent edema
b) diminished distal pulse
c) coolness and pallor of the skin
d) presence of a "hot spot" on the cast

NCLEX RN Questions:
Answers and Rationale

56) D
- Leg elevation is important to increase venous return and decrease edema, which can cause compartment syndrome, a major complication of fractures and casting. Weight-bearing on a fractured extremity is prescribed by the physician during follow-up examination, after radiographs are obtained. Additionally, a walking heel or cast shoe may be added to the cast if the client is allowed to bear weight and walk on the affected leg. Although the client may feel heat after the cast is applied, burning and/or tingling sensations indicate nerve damage or ischemia and are not expected. These complaints should be reported immediately. Option 1 is incorrect. The client and/or family may be taught how to "petal" the cast to prevent skin irritation and breakdown, but rough edges, if trimmed, can fall into the cast and cause a break in skin integrity.

57) D
- Forearm muscle weakness is a sign of radial nerve injury caused by crutch pressure on the axillae. When a client lacks upper body strength, especially in the flexor and extensor muscles of the arms, he or she frequently allows weight to rest on the axillae and on the crutch pads instead of using the arms for support while ambulating with crutches. Leg discomfort is expected as a result of the injury. Triceps muscle spasms may occur as a result of increased muscle use but is not a complication of crutch walking. Weak biceps brachii is a common physical assessment finding in older adults and is not a complication of crutch walking.

58) A
- Weak pedal pulses are a sign of vascular compromise, which can be caused by pressure on the tissues of the leg by the elastic bandage or prefabricated boot used to secure this type of traction.

59) B
- Fracture pain is generally described as sharp, continuous, and increasing in frequency. Bone pain is often described as a dull, deep ache. Strains result from trauma to a muscle body or to the attachment of a tendon from overstretching or overextension. Muscle injury is often described as an aching or cramping pain, or soreness.

60) D
- Signs and symptoms of infection under a casted area include a musty odor or purulent drainage from the cast or the presence of "hot spots," which are areas on the cast that are warmer than others. The physician should be notified if any of these occur.

After you reviewed your answers through its rationale, you can also go back to the first page to start from the beginning:

NCLEX RN Questions about Musculoskeletal Injuries (1-8)

Or proceed to the next set of questions:

NCLEX RN Questions about Musculoskeletal Injuries (61-65)