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This system includes muscles, tendons, bones, ligaments, cartilage, and joints and works with the nervous and circulatory systems to support movement and stability.
Correct response:
What is the musculoskeletal system?
Rationale:
The PowerPoint identifies the muscles/tendons of the muscular system and bones/ligaments/cartilage/joints of the skeletal system as the basic components. Together they support body weight, control movement, and provide stability.
An X-ray reveals that a patient's bone has broken but the skin remains intact. This is the type of fracture.
Correct response:
What is a closed fracture?
Rationale:
A closed fracture occurs when the bone breaks but the skin remains intact. An open fracture occurs when the bone protrudes through the skin and carries increased infection risk.
An open fracture creates a break in the body's protective barrier and increases the risk for this complication.
Correct response:
What is infection?
Rationale:
The fracture lecture specifically identifies impaired skin integrity from an open fracture or surgical correction as increasing the risk for bacterial contamination and infection.
This level of prevention focuses on health promotion and illness prevention before disease occurs.
Correct response:
What is primary prevention?
Rationale:
Primary prevention includes health education, nutrition, exercise, immunizations, safe environments, hygiene, accident prevention, and stress management.
Before delegating a task, the RN must first determine whether the activity falls within the delegatee's scope of practice and competence. This is the first “Right.”
Correct response:
What is the right task?
Rationale:
The five rights of delegation include right task, right circumstances, right person, right communication, and right supervision.
For patients with fractures, these types of medications are primarily used to treat pain.
Correct response:
What are analgesics?
Rationale:
The pharmacologic therapy for fractures primarily includes analgesics for pain.
A patient asks why the nurse keeps checking sensation and movement distal to a fractured extremity. The nurse explains that these assessments are part of this five-part neurovascular assessment.
Correct response:
What are the 5 Ps: pain, pulses, pallor, paresthesia, and paralysis/paresis?
Rationale:
The mobility PowerPoint specifically identifies these five assessments. They help the nurse identify neurovascular changes associated with musculoskeletal injury.
This type of fracture occurs when repetitive forces are repeatedly applied to bone, making athletes particularly susceptible.
Correct response:
What is a stress fracture?
Rationale:
The lecture identifies stress fractures as resulting from small repetitive forces and notes their relationship to sports and exercise.
A patient with an open fracture develops warmth, redness, swelling, fever, chills, and purulent drainage. The nurse recognizes these as signs of this complication.
Correct response:
What is infection?
Rationale:
The lecture lists warmth, redness, pain, swelling, stiffness, fever, chills, and purulent drainage as signs of infection.
A nurse recommends a blood pressure check, mammogram, or cancer screening to detect disease early. These are examples of this level of prevention.
Correct response:
What is secondary prevention?
Rationale:
Secondary prevention focuses on early diagnosis and treatment and usually involves screening tests based on risk factors.
The RN delegates a task to an AP but remains accountable for the overall delegation process. This “Right” requires the RN to monitor, evaluate, intervene, and provide feedback.
Correct response:
What is right supervision?
Rationale:
The PowerPoint states that the RN remains accountable for what is delegated and identifies supervision as guidance, evaluation, follow-up, and feedback.
A patient with a severe fracture reports significant pain despite initial interventions. The provider prescribes this class of medication, which is an option for severe fracture pain.
Correct response:
What are opioids?
Rationale:
Opioids or patient-controlled analgesia are options for severe fracture pain.
A nurse is teaching a patient with impaired mobility about preventing additional injury. The nurse recommends addressing loose rugs, inadequate lighting, and obstructed walkways.
Correct response:
What is environmental safety?
Rationale:
Environmental hazards can increase injury risk in patients with mobility limitations. The PowerPoint specifically identifies loose floor coverings, inadequate lighting, and obstructed walkways as hazards to assess.
A patient with a tibia fracture reports severe pain that seems disproportionate to the injury. The extremity is swollen and increasingly numb, and the distal pulse is decreased. The nurse should suspect this emergency.
Correct response:
What is compartment syndrome?
Rationale:
Compartment syndrome results from increased pressure within a muscle compartment, decreasing blood flow and potentially damaging nerves and muscles. Severe pain, swelling, paresthesia, pallor, numbness/paralysis, and decreased or absent pulses are concerning findings.
The nurse palpates a patient's cast and discovers a localized area of unusual warmth. The nurse recognizes this finding as a possible indication of this problem.
Correct response:
What is infection?
Rationale:
The fracture lecture specifically directs nurses to palpate the cast for “hot spots,” which may indicate infection, and to report drainage promptly.
A patient already has a chronic disease. Nursing interventions focus on medication adherence, nutrition, physical activity, rehabilitation, and minimizing complications. This is what level of prevention?
Correct response:
What is tertiary prevention?
Rationale:
Tertiary prevention seeks to restore health, reduce symptoms, improve well-being, and minimize complications.
A nurse recognizes new abnormal assessment findings in a patient and asks, “What matters most?” According to the Clinical Judgment Measurement Model, this step is called this.
Correct response:
What is recognizing cues?
Rationale:
Recognizing cues involves identifying abnormal assessment findings that may indicate an actual or potential patient problem. The PowerPoint describes these as “red flags.”
A patient with an open fracture receives medication specifically to prevent or treat infection. The nurse recognizes this medication category.
Correct response:
What are antibiotics?
Rationale:
The lecture identifies antibiotics as common medications used to prevent or treat infection in patients with fractures, particularly when infection risk is increased by open fractures or surgical intervention.
A patient asks what is happening in the joint with osteoarthritis. The nurse explains that OA involves degeneration of these two structures and may be accompanied by bone spurs.
Correct response:
What are cartilage and bone?
Rationale:
The lecture describes OA as degeneration of cartilage and bone within a joint, sometimes accompanied by bone spurs or bony growths. The knees, hips, hands, and spine are commonly affected.
An older adult with osteoporosis sustains a hip fracture after a fall. The nurse recognizes that this injury is particularly concerning because it is associated with decreased quality of life and increased risk for this outcome.
Correct response:
What is mortality?
Rationale:
The mobility lecture specifically notes that hip fracture in older adults is associated with decreased quality of life and increased risk for mortality.
A patient with a newly fractured extremity has swelling and requires stabilization. The nurse knows this device is useful because it can be adjusted as swelling changes and may help prevent compartment syndrome.
Correct response:
What is a splint?
Rationale:
Unlike a rigid cast, a splint can be adjusted to accommodate swelling. The lecture notes that splints are commonly used for fresh injuries before swelling subsides and can help prevent compartment syndrome.
A patient says, “I don't exercise because my neighborhood isn't safe for walking.” The nurse recognizes that the patient's health behavior cannot be assessed without considering these broader factors.
Correct response:
What are social determinants of health?
Rationale:
The lecture emphasizes that health is influenced by economic stability, neighborhood and built environment, healthcare access, social/community context, and education.
The nurse must decide which patient problem should be addressed first, considering patient needs and risk factors. This CJMM step asks, “Where do I start?”
Correct response:
What is prioritizing hypotheses?
Rationale:
The PowerPoint identifies appropriate prioritization of patient needs and risk factors as essential when determining what should be addressed first.
A patient with a fracture is at increased risk for a clot because of decreased mobility. The provider prescribes this class of medication to prevent or treat DVT.
Correct response:
What are anticoagulants?
Rationale:
The fracture lecture identifies anticoagulants as medications used to prevent DVT and discusses DVT as a complication of fractures and immobility.
A patient with impaired mobility asks what lifestyle changes can support healthier bones, muscles, and joints. The nurse emphasizes these two interventions because one promotes muscle strength and mineral deposition in bones while the other provides nutrients needed for bone and muscle function.
Correct response:
What are regular exercise and good nutrition?
Rationale:
The mobility lecture identifies good nutrition, adequate calcium intake, and regular exercise as important components of promoting healthy mobility. Exercise promotes muscle strength and mineral deposition in bones while nutrition provides needed nutrients.
A patient with a closed long-bone fracture suddenly develops tachypnea, hypoxia, confusion, and a petechial rash on the upper chest and arms. The nurse recognizes that fat and bone marrow fragments have entered the bloodstream and obstructed smaller blood vessels.
What is Fat Embolism Syndrome (FES)?
Rationale:
Fat embolism syndrome can occur with closed long-bone or pelvic fractures when fat and bone marrow fragments enter the bloodstream and decrease perfusion beyond the blockage. Respiratory manifestations are typically the first symptoms, including tachypnea, dyspnea, and hypoxia. Neurologic changes such as confusion or restlessness and a transient petechial rash are also characteristic findings. Treatment is primarily supportive, including oxygen administration, with some patients requiring mechanical ventilation.
A patient who has been immobile reports discomfort. The nurse plans to reposition the patient and pad bony prominences. The primary purpose is to promote comfort while helping prevent this complication.
Correct response:
What is skin breakdown?
Rationale:
During periods of immobility, proper positioning and padding of joints and bony prominences can reduce discomfort and help prevent skin breakdown.
A patient says, “I have high blood pressure, but I feel completely healthy.” The nurse explains that a person can have a disease without experiencing this.
Correct response:
What is illness? Or What are symptoms of illness?
Rationale:
The health promotion lecture distinguishes disease from illness. A person can have a disease without symptoms of illness; hypertension is specifically given as an example of an often-asymptomatic disease.
The RN is caring for four patients and asks an AP to assist with care. Which task is most appropriate for the RN to delegate, assuming the AP has been trained and the patient's condition is stable?
A. Assess a patient who reports new-onset chest pain
B. Evaluate whether a patient's pain medication was effective
C. Assist a stable patient with bathing and repositioning
D. Determine whether a patient is ready for discharge teaching
Correct response
What is C — assisting a stable patient with bathing and repositioning?
Rationale:
Delegation requires the RN to consider the five rights of delegation: right task, right circumstances, right person, right communication, and right supervision. The RN remains accountable for the delegation process and must ensure that the task is appropriate for the AP's scope and competency.
The other options require nursing assessment, evaluation, clinical judgment, or teaching, which should not simply be delegated to an AP. The stable patient's bathing and repositioning are appropriate supportive care activities when the AP is competent and the RN provides appropriate direction and supervision.
This type of medication may be used cautiously after a fracture to relieve pain and inflammation. However, prolonged or high-doses of this type of medication may interfere with bone healing, so the risks and benefits should be considered.
Correct response:
What are NSAIDs?
Rationale:
Inflammation is a normal and necessary early phase of fracture healing. After a fracture, the inflammatory response helps initiate the repair process by bringing inflammatory cells and signaling molecules to the injured area. This sets the stage for formation of new tissue and bone.
Because of this, there is concern that NSAIDs and other anti-inflammatory medications could potentially interfere with early bone healing if they suppress this inflammatory response too much or for too long.