A2 EX.4 CH.40 PREP U Musculoskeletal

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse? "CPM strengthens the muscles of the leg." "CPM delivers analgesic agents directly into the joint." "CPM increases range of motion of the joint." "CPM prevents injury by limiting flexion of the knee."

"CPM increases range of motion of the joint." also increases circulation

A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first? "My toes are stiff." "My pain is a 3." "My toes are pink." "My cast is still wet."

"My toes are stiff."

A client diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse? "When a spica cast is ordered, the arm must be immobilized." "The joint above the fracture and below the fracture must be immobilized." "The method allows for the fastest healing time and the greatest mobility." "This allows for the strength in the arm to remain consistent."

"The joint above the fracture and below the fracture must be immobilized."

The nurse is caring for a patient with a total hip replacement. How should the nurse allow the patient to turn? To any comfortable position as long as the affected leg is extended 45 degrees onto the unoperated side if the affected hip is kept abducted To the operative side if the affected hip remains extended From the prone to the supine position only, and the patient must keep the affected hip extended and abducted

45 degrees onto the unoperated side if the affected hip is kept abducted keep the operative hip in abduction (movement away from the center or median line of the body) Never flex pt hip more than 90 degrees.

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? An open reduction A total hip replacement A total knee replacement A fasciotomy

A fasciotomy

Which would be an inappropriate initial pain relief measure for the client with a cast? Application of a new cast Application of cold packs Elevation of the involved part Administration of analgesics

Application of a new cast

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? Scrub the area vigorously to remove the crust. Apply lotions and take warm baths or soaks. Consult a skin specialist. Avoid exposure to direct sunlight.

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

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse? Teach relaxation techniques. Assess for previous opioid drug use. Reposition the client for comfort. Assess for complications.

Assess for complications.

Which action would be most important postoperatively for a client who has had a knee or hip replacement? Assisting in early ambulation. Encouraging expressions of anxiety. Providing crutches to the client. Using a continuous passive motion (CPM) machine.

Assisting in early ambulation.

A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast? Quicker drying Longer lasting More breathable Better molding to the client

Better molding to the client longer drying time

Which would be consistent as a component of self-care activities for the client with a cast? Frequently place the casted extremity in a dependent position Cover the cast with plastic to insulate it Cushion rough edges of the cast with tape Use a plastic hanger wrapped in gauze to scratch under the cast.

Cushion rough edges of the cast with tape the cast should be kept dry the extremity should be elevated to heart level freq.

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? Elevate the affected extremity and use cold applications. Apply antiembolism stockings as indicated. Do ROM exercises as indicated. Breathe deeply and cough every 2 hours until ambulation is possible.

Elevate the affected extremity and use cold applications to reduce swelling

A nurse is caring for a client after stabilization of a radial fracture. Which actions by the nurse would be appropriate for the client following arm casting? Select all that apply. Circulate room air with a portable fan Handle the cast with the palms of hands Elevate the arm on a plastic-covered pillow Protect the cast by covering with a sheet Petal and smooth the edges of the cast

Handle the cast with the palms of hands Circulate room air with a portable fan Petal and smooth the edges of the cast

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength. Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. Have the patient extend both hands while the nurse compares the volume of both radial pulses. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, "How can I stay like this for weeks? I can't even move!" Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis? Deficient Diversional Activity related to prolonged hospitalization Ineffective Coping related to prolonged immobility Impaired Physical Mobility related to traction Activity Intolerance related to impaired mobility

Ineffective Coping related to prolonged immobility

A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for? Open reduction and internal fixation of the left hip. Closed reduction of the left hip. Left hip arthroplasty Left hip arthroscopy

Left hip arthroplasty

The nurse is caring for a client with an external fixator that requires pin care twice a day. The nurse observes that there is a new purulent drainage around one of the pins. What intervention should the nurse anticipate doing? Apply ointment to the pin site. Scrubbing the drainage from around the pin site Applying iodine-based solution Obtaining a culture

Obtaining a culture

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? Internal fixation Open reduction Buck's traction Skeletal traction

Open reduction

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? Open reduction Arthrodesis Total joint arthroplasty Joint arthroplasty

Open reduction

A nurse is giving instructions to a client who's going home with a leg cast. Which teaching point is most critical? Avoiding walking on a leg cast without the health care provider's permission Reporting signs of impaired circulation Using crutches properly Exercising joints above and below the cast, as ordered

Reporting signs of impaired circulation

pelvic traction

SKIN traction applied to the lower spine, with a belt around the waist.

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain? Sharp and piercing A dull, deep, boring ache Similar to "muscle cramps" Sore and aching

Sharp and piercing

A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied? Long leg cast Short leg cast Hip spica cast Walking cast

Short leg cast

Which principle applies to the client in traction? Weights are removed routinely. Knots in the ropes should touch the pulley. Weights should rest on the bed. Skeletal traction is never interrupted.

Skeletal traction is never interrupted.

Which device is designed specifically to initially support and immobilize a body part in a desired position until swelling subsides? Brace Continuous passive motion (CPM) device Trapeze Splint

Splint

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? Teach the client how to prevent problems caused by immobility. Assess the client's level of consciousness. Remove the traction at least every 8 hours. Apply the traction straps snugly.

Teach the client how to prevent problems caused by immobility. - apply traction straps.

Which statement is accurate regarding care of a plaster cast? The cast can be dented while it is damp. The cast will dry in about 12 hours. A dry plaster cast is dull and gray. The cast must be covered with a blanket to keep it moist during the first 24 hours.

The cast can be dented while it is damp. WILL DRY IN 24-72 HOURS AND SHOULD NOT BE COVERED WHILE DRYING

Which is not a guideline for avoiding hip dislocation after replacement surgery. The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. Never cross the legs when seated. Put a pillow between the legs when sleeping. Keep the knees apart at all times.

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes.

skeletal traction

The most effective means of traction, applying to a bone with wire pins or tongs

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed? The leg will look moist and will have small bumps that will go away in a few days. The leg strength is enforced by the wearing of the cast. The leg will look as it did prior to the cast being applied. The skin may be covered with a yellowish crust that will shed in a few days.

The skin may be covered with a yellowish crust that will shed in a few days. The leg may be weak and stiff for some time after the cast is removed

Why do we not turn a patient to the operative side after a total hip replacement?

This could cause dislocation, unless specified by the surgeon

What does a dry plaster cast look like?

White and shiny

CPM device

a device that promotes range of motion, circulation, and healing

external fixation

a fracture treatment procedure in which pins are placed through the soft tissues and bone so that an external applicance can be used to hold the pieces of bone firmly in place during healing

fasciotomy

a surgical incision through the fascia to relieve tension or pressure

Fiberglass cast

casts dry more quickly, are lighter in weight, longer lasting, and breathable.

compartment syndrome

characterized by neurovascular compromise. Stiffness of the toes may be a preliminary finding that the client is having trouble with motor function

CPM

continuous passive motion

Why do we use a brace?

externally applied device to support a body part, control movement, and prevent injury

Arthrodesis is: replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain. cutting and removal of a wedge of bone (most often the tibia or femur) to change the bone's alignment, thereby improving function and relieving pain. fusion of a joint (most often the wrist or knee) for stabilization and pain relief.

fusion of a joint (most often the wrist or knee) for stabilization and pain relief.

compartment syndrome

involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles

internal fixation

involves the use of metal screws, plates, rods, nails or pins to stabilize a reduced fracture.

A client undergoes an open reduction of a femur fracture, and returns to the orthopedic unit with a cast in place. What is the rationale for frequently assessing the client's pedal pulses? ensuring there wasn't nerve damage during surgery ensuring surgery was successful maintaining adequate circulation typical postoperative nursing management

maintaining adequate circulation

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period? osteomyelitis infection hemorrhage hematoma

osteomyelitis Chronic osteomyelitis may occur after persistent infection in the late postoperative period

trapeze

overhead assistive device to promote patient mobility in bed

Homan's sign

pain in *calf upon dorsiflexion* of foot and may indicated thrombophlebitis

Hemiarthroplasty

replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum

Pearson attachment

supports lower leg, and provides increased stability in the overall traction setup, it does not prevent flexion deformities in the ankle or foot, not attached to skeletal pin

A client with a right leg fracture is returning to the orthopedist to have the cast removed. During cast removal, it is important for the nurse to assure: the client that he or she won't be cut. that pedal pulses are present. that the leg will be as good as new. that the cast cutter blade is new.

the client that he or she won't be cut.

arthroplasty

total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain

buck's traction

type of skin traction that provides pulling on the structures