CH 41
A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction? a) Buck's b) Balanced suspension c) Thomas splint d) Crutchfield tongs
Buck's Explanation: An example of skin traction is Buck's traction. Crutchfield tongs, a Thomas splint, or balanced suspension traction are types of skeletal traction.
A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client? a) Cutting of a bivalve cast b) Removal of the cast c) Cutting a cast window d) Insertion of an external fixator
Cutting a cast window Explanation: After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing. A bivalve cast is when the cast is cut in two if the leg swells or if the client is being weaned from a cast, when a sharp x-ray is needed, or as a splint for immobilizing painful joints when a client has arthritis. The cast should not be removed due to the instability of a fracture. The client's condition does not indicate an external fixator is required.
Which evaluation finding requires follow up by the nurse caring for a client with a total knee replacement? Select all that apply. a) Pedal pulses strong and equal bilaterally b) 650 ml bloody drainage in drain wound c) Client reports pain rating of 2. d) Client ambulates 10 feet by postoperative day 2 e) Knee flexion at 30 degrees
• 650 ml bloody drainage in drain wound • Knee flexion at 30 degrees Explanation: A suction drain removes fluid accumulating in the wound. Typical drainage ranges from 200 to 400 ml the first 24 hours after surgery and declines to fewer then 25 ml by 48 hours. Knee mobility is increased with a continuous passive motion (CPM) device. Initial settings of the CPM are usually 10 degrees of extension and 50 degrees of flexion with an ultimate goal of full extension (0 degrees) and 90 degrees of flexion by discharge. A pain rating of 2 is an indicator of effective pain management. Strong and equal pedal pulses are an expected finding. Progressive ambulation begins on the day after surgery; ambulating 10 feet on postoperative day would be expected.
Which action would be most important postoperatively for a client who has had a knee or hip replacement? a) Using a continuous passive motion (CPM) machine. b) Encouraging expressions of anxiety. c) Providing crutches to the client. d) Assisting in early ambulation.
Assisting in early ambulation. Explanation: An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement. A CPM machine or crutches may be provided when prescribed. It is important to encourage clients to express their feelings of anxiety or depression. This is more crucial for clients who undergo an amputation rather than for clients who undergo a replacement surgery.
Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. The best response by the nurse is: a) "CPM increases range of motion of the joint." b) "CPM delivers analgesic agents directly into the joint." c) "CPM strengthens the muscles of the leg." d) "CPM prevents injury by limiting flexion of the knee."
"CPM increases range of motion of the joint." Explanation: CPM increases circulation and range of motion of the knee joint.
The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Farenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which of the following complications? a) Osteomyelitis b) Hypovolemic shock c) Atelectasis d) Urinary retention
Hypovolemic shock Explanation: Indicators of hypovolemic shock include a heart rate greater than 100 beats per minute, a blood pressure less than 90/60 mm Hg, and urine output less than 30 ml per hour.
The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? a) "Metal pins will go through my skin to the bone." b) "I will wear a boot with weights attached." c) "A belt will go around my pelvis and weights will be attached." d) "The traction can be removed once a day so I can shower."
"Metal pins will go through my skin to the bone." Explanation: In skeletal traction, metal rods or pins are used to apply continuous traction directly to the bone. Weights are used to apply the traction. Casts, external fixators, or splints are used when the traction is discontinued.
Which of the following would be an inconsistent initial pain relief measure for the patient with a cast? a) Application of a new cast b) Application of cold packs c) Elevation of the involved part d) Administration of analgesics
Application of a new cast Explanation: Most pain can be relieved by elevating the casted part of the body, and by applying cold packs as prescribed and administering analgesics. Application of a new cast is usually not necessary.
The nurse is caring for a client with a spica cast. A priority nursing intervention is to: a) Keep the legs in abduction. b) Keep the cast clean and dry. c) Position the client on the affected side. d) Promote elimination with a regular bedpan.
Keep the cast clean and dry. Explanation: Keeping the cast clean and dry around the perineal opening is a priority. A spica cast has a built-in abduction bar. The client should be positioned on the unaffected side every 2 hours and prone twice a day. A fracture bedpan is easier to use for the client with a spica cast.
A nurse is giving instructions to a client who's going home with a cast on his leg. Which teaching point is most critical? a) Using crutches properly b) Reporting signs of impaired circulation c) Exercising joints above and below the cast, as ordered d) Avoiding walking on a leg cast without the physician's permission
Reporting signs of impaired circulation Explanation: Although all of these points are important, reporting signs of impaired circulation is the most critical. Signs of impaired circulation must be reported to the physician immediately to prevent permanent damage. The other options reflect more long-term concerns. The client should learn to use his crutches properly to avoid nerve damage. The client may exercise above and below the cast, as the physician orders. The client should be told not to walk on the cast without the physician's permission.
Conservative treatment of a compressed nerve root is first line treatment. What conservative treatment is used to increase the distance between vertebrae and decrease severe muscle spasm? a) Sleeping on a hard mattress with a bed board b) Cool, moist compresses c) Skeletal traction d) Skin traction
Skin traction Explanation: Skin traction, which can be applied in the home, is used to decrease severe muscle spasm as well as increase the distance between adjacent vertebrae, keep the vertebrae correctly aligned, and, in many instances, relieve pain. Treatment relieves symptoms for an extended period.
Which of the following statements is accurate regarding care of a plaster cast? a) The cast will dry in about 12 hours. b) A dry plaster cast is dull and gray. c) The cast must be covered with a blanket to keep it moist during the first 24 hours. d) The cast can be dented while it is damp.
The cast can be dented while it is damp. Explanation: The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding.
A patient is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm? a) Proper use of a sling b) Use of isometric exercises c) Abduction and adduction of the shoulder d) Repositioning the arm in the cast
Use of isometric exercises Explanation: Isometric exercises allow for use of the muscle without moving the bone. Doing isometric exercises every hour while the patient is awake will help prevent disuse syndrome. Proper use of a sling does not prevent disuse syndrome. The patient should not attempt to reposition the arm in the cast. Abduction and adduction of the shoulder will help the shoulder joint but does not require the use of muscles in the lower arm.
The client displays manifestations of compartment syndrome. The nurse expects the client to be scheduled for: a) A total hip replacement b) A total knee replacement c) An open reduction d) A fasciotomy
A fasciotomy Explanation: A treatment option for compartment is fasciotomy.
A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? a) Keeping the client from sliding to the foot of the bed b) Assessing the extremity for neurovascular integrity c) Keeping the ropes over the center of the pulley d) Ensuring that the weights hang free at all times
Assessing the extremity for neuromuscular integrity Explanation: Although all measures are correct, assessing neurovascular integrity takes priority because a decrease in neurovascular integrity could compromise the limb. The pull of the traction must be continuous to keep the client from sliding. Sufficient countertraction must be maintained at all times by keeping the ropes over the center of the pulley. The line of pull is maintained by allowing the weights to hang free.
A group of students are 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? a) Better molding to the client b) Longer-lasting c) Quicker drying d) More breathable
Better molding to the client Explanation: Plaster casts require a longer time for drying, but mold better to the client, and are initially used until the swelling subsides. Fiberglass casts dry more quickly, are lighter in weight, longer-lasting, and breathable.
A client who is undergoing skeletal traction complains of pressure on bony areas. Which action would be most appropriate to provide comfort for the client? a) Applying warm compresses. b) Changing the client's position within prescribed limits. c) Assisting with range-of-motion and isometric exercises. d) Administering prescribed analgesics.
Changing the client's position within prescribed limits. Explanation: Changing the position of a client within prescribed limits helps relieve pressure on bony areas and promotes comfort. Analgesics help to relive pain but may not help relieve pressure on bony areas. Warm compresses aid blood circulation. The client should not exercise while on traction unless prescribed to regain strength in the affected limb.
A patient with a tibia fracture was placed in an external fixator 24 hours ago. The nurse is completing pin care and notices redness at the pin site and a small amount of serous drainage. What action by the nurse is appropriate? a) Assess patient's hemoglobin and hematocrit. b) Prepare for surgical removal of the fixator. c) Document the findings. d) Notify the physician.
Document the findings. Explanation: Serous drainage and redness at the pin site is an expected finding for 24-48 hours postinsertion. The nurse should document the findings and continue to monitor the site. The physician does not need to be notified unless other signs and symptoms are present. The fixator does not need to be removed at this time. The greatest concern is for infection; assessing the hemoglobin and hematocrit are not relevant to assessing for infection.
Mr. Williams returned to the nursing unit following orthopedic surgery and is complaining of pain. Which of the following interventions will help relieve pain? a) Instruct client to deep breathe and cough every 2 hours until he can ambulate. b) Elevate the affected extremity and use cold applications. c) Encourage client to do ROM exercises as indicated. d) Apply antiembolism stockings as indicated.
Elevate the affected extremity and use cold applications. Explanation: Elevating the affected extremity and using cold applications reduce swelling. This intervention helps with maintenance of effective respiratory rate and depth. This intervention helps maintain full ROM of unaffected joints. They help prevent deep vein thrombosis (DVT).
Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure? a) Osteotomy b) Fasciotomy c) Arthrodesis d) Arthroplasty
Fasciotomy Explanation: A fasciotomy is a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure. An osteotomy is a surgical cutting of bone. An arthroplasty is a surgical repair of a joint. Arthrodesis is a surgical fusion of a joint.
A client has just undergone a leg amputation. The nurse would closely monitor the client for which of the following during the immediate postoperative period? a) Neuroma b) Chronic osteomyelitis c) Unexplainable burning pain (causalgia) d) Hematoma
Hematoma Explanation: Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period. Sleeplessness, nausea, and vomiting may occur but are adverse reactions, not complications. Chronic osteomyelitis and causalgia are potential complications that are likely to arise in the late postoperative period. A neuroma occurs when the cut ends of the nerves become entangled in the healing scar. This would occur later in the postoperative course.
To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan? a) Increase fiber intake. b) Reduce fluid intake. c) Remove the weights during linen changes. d) Increase calorie intake.
Increase fiber intake. Explanation: Immobility increases the incidence of constipation. Increasing fiber intake will reduce GI complications. The weights in traction should never be removed. Inactivity results in fewer calories being burned. Increasing calories would be counterproductive. Reducing fluids will increase the likelihood of constipation.
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? a) Ineffective Coping related to prolonged immobility b) Deficient Diversional Activity related to prolonged hospitalization c) Activity Intolerance related to impaired mobility d) Impaired Physical Mobility related to traction
Ineffective Coping related to prolonged immobility Explanation: The client is displaying clinical manifestations of anxiety and ineffective coping.
Which of the following is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? a) It prevents infection and controls edema and bleeding. b) It provides active range of motion. c) It promotes healing by increasing circulation and movement of the knee joint. d) It promotes healing by immobilizing the knee joint.
It promotes healing by increasing circulation and movement of the knee joint. Explanation: A CPM device applied after knee surgery promotes healing by increasing circulation and movement of the knee joint.
A 12-year-old client fractured her right leg while skiing and is undergoing an open reduction of the femur fracture. She returns to the orthopedic unit where you practice nursing with a cast in place. What is the rationale for frequently assessing her pedal pulses? a) Making sure surgery was successful b) Typical postoperative nursing management c) Ensuring there wasn't nerve damage during surgery d) Maintaining adequate circulation
Maintaining adequate circulation Explanation: Circulation, sensation, and mobility of exposed fingers or toes must be assessed every 1 to 2 hours to ensure neurovascular status is not compromised.
Which of the following is an inaccurate principle of traction? a) The weights must hang freely. b) The patient must be in good alignment in the center of the bed. c) The weights are not removed unless intermittent treatment is prescribed. d) Skeletal traction is interrupted to turn and reposition the patient.
Skeletal traction is interrupted to turn and reposition the patient. Explanation: Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely with the patient in good alignment in the center of the bed.
The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? a) Weights hanging and touching the floor b) Pulleys without evidence of the obstruction c) Ropes freely moving over pulleys d) Body aligned opposite to line of traction pull
Weights hanging and touching the floor Explanation: When checking traction equipment, the weights should be freely hanging. Weights that touch the floor require the nurse to intervene. The body should be aligned in an opposite line to the pull of the traction. The ropes should be freely moving over unobstructed pulleys.
Meniscectomy refers to the a) replacement of one of the articular surfaces of a joint. b) incision and diversion of the muscle fascia. c) removal of a body part. d) excision of damaged joint fibrocartilage.
excision of damaged joint fibrocartilage. Explanation: The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint. Amputation refers to the removal of a body part.
Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) a) "It is okay to briefly flex the hip to put on your clothes." b) "Use a raised toilet seat and high-seated chair." c) "You may cross your legs at the ankles only." d) "Place pillows between your legs when you lay on your side." e) "Avoid bending forward when sitting in a chair."
• "Use a raised toilet seat and high-seated chair." • "Place pillows between your legs when you lay on your side." • "Avoid bending forward when sitting in a chair." Explanation: The client following post hip replacement should not cross the legs, even at the ankle. He or she should avoid bending forward when sitting in a chair, avoid flexing the hip when dressing, and use a raised toilet seat. A pillow should be placed between the legs when side-lying.
Which of the following orthopedic surgeries is done to correct and align a fracture after surgical dissection and exposure of the fracture? a) Open reduction b) Total joint arthroplasty c) Arthrodesis d) Joint arthroplasty
Open reduction Explanation: An open reduction is the correction and alignment of the fracture after surgical dissection and exposure of the fracture. Arthrodesis is immobilizing fusion of a joint. A joint arthroplasty or replacement is the replacement of joint surfaces with metal or synthetic materials. A total joint arthroplasty is the replacement of both the articular surfaces within a joint with metal or synthetic materials.
The client presents with nausea and vomiting, sluggish bowel sounds, and abdominal distention. The nurse interprets these findings as suggestive of: a) Physiologic cast syndrome b) Impaired physical mobility c) Psychological cast syndrome d) Disuse syndrome
Physiologic cast syndrome Explanation: Physiological cast syndrome is characterized by impaired gastrointestinal function, such as nausea and vomiting, sluggish bowel sounds, and abdominal distention.
A client sustained a stable fracture of the cervical spine and is having skeletal traction applied. What type of traction does the nurse educate the client about? a) Crutchfield tongs b) Thomas splint c) Kirschner wires d) Steinmann pins
Crutchfield tongs Explanation: Crutchfield tongs are cranial tongs that are used to maintain alignment for a cervical fracture. Kirschner wires and Steinmann pins are used for the skeletal traction to attach to. A Thomas splint is used to suspend a leg in traction.
Which type of cast encloses the trunk and a lower extremity? a) Body cast b) Hip spica c) Short-leg d) Long-leg
Hip spica Explanation: A hip spica cast encloses the trunk and a lower extremity. A body cast encloses the trunk. A long-leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. A short-leg cast extends from below the knee to the base of the toes.
Which intervention should the nurse implement with the client who has undergone a hip replacement? a) Have the client bend forward to rise from the chair. b) Place the client in high Fowler's position for meals. c) Instruct the client to avoid internal rotation of the leg. d) Adduct the legs by placing a pillow between the legs.
Instruct the client to avoid internal rotation of the leg. Explanation: The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. A pillow is used to keep the legs in abduction. The hip should not bend more than 90 degrees when seated. The head of bed should be kept at 60 degrees or less.
A client has undergone an external fixation. Which actions would be the priority for this client? a) Planning the client's diet. b) Monitoring the client's urine output. c) Monitoring the client's blood pressure. d) Maintaining pin care.
Maintaining pin care. Correct Explanation: Pin care is a priority for a client with external fixation, because pin sites are entry points for infection. The nurse should also monitor redness, drainage, and tenderness at the site. Planning the client's diet and monitoring the client's urine output and blood pressure, although necessary, are not as important as maintaining pin care.
The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is: a) Risk for avascular necrosis of the joint b) Disturbed body image c) Situational low self-esteem d) Risk for ineffective therapeutic regimen management
Risk for ineffective therapeutic regimen management Explanation: The client without adequate support and resources is at risk for ineffective therapeutic regimen management. A total knee replacement may be used to treat avascular necrosis. While an orthopedic client is at risk for disturbed body image and situational low self-esteem, there is no evidence that these exist for this client.
Which of the following principles apply to the patient in traction? a) Knots in the ropes should touch the pulley b) Skeletal traction is never interrupted c) Weights are removed routinely d) Weights should rest on the bed
Skeletal traction is never interrupted Explanation: Skeletal traction is applied directly to the bone and is never interrupted. In order to be effective, the weights must hang freely and not rest on the bed or floor. Knots in the rope or the footplate must not touch the pulley or the foot of the bed. Traction must be continuous to be effective in reducing and immobilizing fractures.
All of the following are guidelines for avoiding hip dislocation after replacement surgery. Select the answer that is not. a) Never cross the legs when seated. b) Put a pillow between the legs when sleeping. c) Keep the knees apart at all times. d) You may flex at the hip to put on clothing such as pants, stockings, socks, or shoes.
You may flex at the hip to put on clothing such as pants, stockings, socks, or shoes. Explanation: "Do not flex at the hip to put on clothing such as pants, stockings, socks, or shoes" is the correct guideline. Keep the knees apart at all times. Put a pillow between the legs when sleeping. Never cross the legs when seated.
Which of the following would be inconsistent as a component of self-care activities for the patient with a cast? a) Do not attempt to scratch the skin under a cast b) Elevate the casted extremity to heart level frequently c) Cover the cast with plastic to insulate it d) Cushioning rough edges of the cast with tape
Cover the cast with plastic to insulate it Explanation: The cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. The other activities are consistent with cast care.
The nurse teaches the patient which of the following interventions in order to avoid hip dislocation after replacement surgery? a) Keep the knees together at all times b) Never cross the affected leg when seated c) Bend forward only when seated in a chair d) Avoid placing a pillow between the legs when sleeping
Never cross the affected leg when seated Explanation: Crossing the affected leg may result in dislocation of the hip joint after total hip replacement. The patient should be taught to keep the knees apart at all times. The patient should be taught to put a pillow between the legs when sleeping. The patient should be taught to avoid bending forward when seated in a chair.
The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fracture tibia. What should the nurse inform the client prior to the cast being removed? a) The skin may be covered with a yellowish crust that will shed in a few days. b) The leg will look as it did prior to the cast being applied. c) The leg will look moist and will have small bumps that will go away in a few days. d) The leg strength is enforced by the wearing of the cast.
The skin may be covered with a yellowish crust that will shed in a few days. Explanation: Once the cast is off, the skin appears mottled and may be covered with a yellowish crust composed of accumulated body oil and dead skin. The client usually sheds this residue in a few days. The leg will not look as it did prior to the cast but will regain the same shape and status as the other leg. There should be no bumps underneath the cast. The leg may be weak and stiff for some time after the cast is removed, not stronger.
The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? a) Blood pressure of 140/90 mm Hg b) Crackles in the lung bases c) Client complains of pain in the affected rib area when taking a deep breath d) Heart rate of 94 beats/minute
Crackles in the lung bases Explanation: Crackles in the lung bases can be an indicator that the client has developed pneumonia from shallow respirations. The blood pressure is high but may be due to pain. It is expected that the client will have pain in the rib area when taking deep breaths. A heart rate of 94 beats/minuteis within normal range
Which of the following is an inappropriate nursing diagnosis for the client following casting? a) Risk for impaired skin integrity b) Risk for deficient knowledge: procedure c) Risk for impaired tissue perfusion d) Risk for disuse syndrome
Risk for deficient knowledge: procedure Explanation: The client needs adequate information before experiencing the procedure. Information about its purpose, the actual steps of the procedure, and the client's role during and after the procedure is essential. Appropriate nursing diagnoses following the procedure would include risk for disuse syndrome, risk for impaired skin integrity, and risk for impaired tissue perfusion.
A client was playing softball and dislocated four of his fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as? a) Closed reduction b) Open reduction with internal fixation c) Open reduction d) External fixation
Closed reduction Explanation: In a closed reduction, the bone is restored to its normal position by external manipulation. A bandage, cast, or traction then immobilizes the area. In an open reduction, the bone is surgically exposed in the operating room and realigned. If internal fixation is needed to stabilize a reduced fracture, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pin.
The nurse is caring for a client who has had a fracture reduction using a cast. Which of the following would be most important for the nurse to assess? a) Sleep status b) Renal function c) Neurovascular status d) Cardiac status
Neurovascular status Explanation: When caring for a client with a fracture, the nurse should carefully assess neurovascular status, checking for possible complications. Assessment of cardiac and renal status would be priorities if the client experienced multiple fractures or had an open reduction. The client's sleep status would be a low priority.
A client's fracture was reduced by surgically exposing the bone and realigning it. The nurse identifies this as which of the following? a) Buck's traction b) Internal fixation c) Open reduction d) Skeletal traction
Open reduction Explanation: In an open reduction, the bone is surgically exposed and realigned. Buck's traction is a type of skin traction that provides pulling on the structures. Skeletal traction is applied directly to the bone using a wire, pin, or cranial tongs. Internal fixation involves the use of metal screws, plates, rods, nails or pins to stabilize a reduced fracture.
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? a) Avoid exposure to direct sunlight. b) Apply lotions and take warm baths or soaks. c) Scrub the area vigorously to remove the crust. d) Consult a skin specialist.
Apply lotions and take warm baths or soaks. Explanation: The client should be advised to 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. It is not advisable to scrub the area vigorously. The client need not avoid exposure to direct sunlight because the area is not photosensitive.
A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse? a) "The splint is less expensive than the cast." b) "You will be able to wear the splint longer than you would a cast." c) "We will need to monitor the status of the laceration to be sure it does not get infected." d) "The arm does not require the same immobilization that a leg fracture would."
"We will need to monitor the status of the laceration to be sure it does not get infected." Explanation: A splint would be used when there is special skin treatment or observation that is required. The arm fracture would require the same form of immobilization that a leg fracture does. The length of time the splint can be worn is equal to that of a cast to immobilize the fracture. The cost of the splint and cast would be similar.
A nurse is caring for a client with a cast on his left arm after sustaining a fracture. Which assessment finding is most significant for this client? a) Cast edges are rough, with skin irritation present b) Presence of a normal popliteal pulse c) Fingers on the left hand are swollen and cool d) Minimal pain in the left arm
Fingers on the left hand are swollen and cool Explanation: Swollen and cool fingers on the left hand are the most significant assessment findings. They represent altered circulation to the hand caused by the cast. A normal radial, not popliteal, pulse should be present in the left arm; the popliteal pulse is found on the leg. Skin irritation is an abnormal assessment finding but it isn't as significant as altered circulation. Minimal pain in the left arm is expected.
A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? a) Arthrodesis b) Total arthroplasty c) Hemiarthroplasty d) Osteotomy
Total arthroplasty Explanation: A total arthroplasty is a replacement of both articular surfaces within one joint. An arthrodesis is a fusion of a joint for stabilization and pain relief and is usually done on a wrist or knee. A hemiarthroplastyis the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. An osteotomy is the cutting and removal of a wedge of bone to change the bone's alignment, thereby improving function and relieving pain.
A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply. a) Immobilization of the left leg will be maintained. b) The bones of the left leg will be aligned. c) Less pain medication will be required. d) Muscle spasms will be relieved. e) Surgery will not be required.
• Immobilization of the left leg will be maintained. • The bones of the left leg will be aligned. • Muscle spasms will be relieved. Explanation: Traction is used to relieve muscle spasm, align bones, and maintain immobilization when used properly. It will not replace surgery to correct the fracture. The client will still require pain medication prior to surgical correction.
When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide? a) "Intermittently cross and uncross your legs several times each day." b) "Avoid weight bearing until the hip is completely healed." c) "Limit hip flexion to 90 degrees." d) "Perform rotation exercises each day."
"Limit hip flexion to 90 degrees." Explanation: The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. The hip should not bend more than 90 degrees. Ambulation begins the day following surgery, and weight bearing ambulation may not be restricted, depending on the type of prosthesis.
A patient 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? a) "The method will allow for the fastest healing time and the greatest mobility." b) "This will allow for the strength in the arm to remain consistent." c) "The joint above the fracture and below the fracture must be immobilized." d) "When a spica cast is ordered, the arm must be immobilized."
"The joint above the fracture and below the fracture must be immobilized." Explanation: Generally, the joints proximal and distal to the fracture are immobilized to promote healing. The purpose is not for the strength to remain consistent, most patients will lose strength. A spica cast would not be ordered for an ulnar fracture. Although immobilizing the joints above and below fractures may aide in healing time, it does not allow for increased mobility.
A client has a Fiberglas cast on the right arm. Which action should the nurse include in the care plan? a) Assessing movement and sensation in the fingers of the right hand b) Keeping the casted arm warm by covering it with a light blanket c) Avoiding handling the cast for 24 hours or until it is dry d) Evaluating pedal and posterior tibial pulses every 2 hours
Assessing movement and sensation in the fingers of the right hand Explanation: The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting circulation. To reduce the risk of skin breakdown, the nurse should leave a casted arm uncovered, which allows air to circulate through the cast pores to the skin below. Unlike a plaster cast, a Fiberglas cast dries quickly and can be handled without damage soon after application. The nurse should assess the brachial and radial pulses distal to the cast — not the pedal and posterior tibial pulses, which are found in the legs.
Which of the following definitions describes the hip spica cast? a) Encircles the trunk b) Extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed. c) A short or long leg cast reinforced for strength d) Encloses the trunk and a lower extremity
Encloses the trunk and a lower extremity Explanation: A hip spica cast encloses the trunk and a lower extremity. A double hip spica cast includes both legs. A body cast encircles the trunk. A walking cast is a short or long leg cast reinforced for strength. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.
Which action by the nurse would be inappropriate for the client following casting? a) Petal and smooth the edges of the cast. b) Protect the cast by covering with a sheet. c) Circulate room air with a portable fan. d) Handle the cast with the palms of hands.
Protect the cast by covering with a sheet. Explanation: The nurse performs actions to facilitate drying of the cast. The cast should be exposed to air. Portable fans can be used to dry the cast. Pressure on the cast should be avoided.
A 19-year-old client presents at the emergency department with a compound fracture of the right femur. Skeletal traction is applied to align the bones. What type of traction would you expect to be used? a) Russell traction b) Thomas splint c) Buck's traction d) Steinmann traction
Steinmann traction Explanation: Skeletal traction is applied directly to a bone by using a wire (Kirschner), pin (Steinmann), or cranial tongs (Crutchfield). General or local anesthesia may be used when inserting these devices.
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? a) Apply the traction straps snugly. b) Assess the client's level of consciousness. c) Remove the traction at least every 8 hours. d) Teach the client how to prevent problems caused by immobility.
Teach the client how to prevent problems caused by immobility. Explanation: By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removing skeletal traction is the physician's responsibility — not the nurse's.
A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client? a) Urging her to keep the affected limb in an elevated position. b) Advising the client to avoid red meat. c) Exploring factors related to the client's home environment. d) Educating the client about the effects of menopause.
Exploring factors related to the client's home environment. Explanation: Exploring factors related to the older adult client's home environment and determining a plan for continued rehabilitation before discharge is most important. The client should be encouraged to eat foods rich in protein, calcium, and vitamin D. Since the healing is almost complete, the client need not always keep the affected limb elevated unless prescribed to do so. Since the client is in her late 60s, she is most likely to have already undergone menopause. Therefore, educating her about the effects of menopause is not as important.
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? a) Left hip arthroscopy b) Open reduction and internal fixation of the left hip. c) Closed reduction of the left hip. d) Left hip arthroplasty
Left hip arthroplasty Explanation: Clients with arthritis, trauma, hip fracture, or a congenital deformity may have an arthroplasty, or reconstruction of the joint. This procedure uses an artificial joint that restores previously lost function and relieves pain. An arthroscopy is not used to reconstruct a diseased hip. A closed reduction is not an invasive surgical procedure and would not be used to reconstruct the hip. An open reduction and internal fixation is not the treatment for reconstruction of the hip related to a diseased hip.
After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority? a) Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use b) Supporting the traction weights with a chair or table to prevent accidental slippage c) Monitoring the client for skin breakdown d) Maintaining traction continuously to ensure its effectiveness
Maintaining traction continuously to ensure its effectiveness Explanation: The nurse must maintain skeletal traction continuously to ensure its effectiveness. The nurse should assess skin for breakdown; however, maintaining skeletal traction takes priority. Traction weights must hang freely to be effective; they should never be supported. The nurse should increase, not restrict, the client's fluid and fiber intake (unless contraindicated by a concurrent illness) to prevent constipation associated with complete bed rest.
A patient in the emergency department is being treated for a wrist fracture. The patient asks why a splint is being applied instead of a cast. What is the best response by the nurse? a) "It is best if an orthopedic doctor applies the cast." b) "Not all fractures require a cast." c) "A splint is applied when more swelling is expected at the site of injury." d) "You would have to stay here much longer because it takes a cast longer to dry."
"A splint is applied when more swelling is expected at the site of injury." Explanation: Splints are noncircumferential and will not compromise circulation when swelling is expected. A splint is applied to support and immobilize the injured joint. A fracture will experience swelling as part of the inflammation process. The patient would not have to stay longer if a fiberglass cast is applied. Fiberglass cast dry in approximately 30 minutes. An orthopedic doctor is not needed to apply the cast. Many nurses and technicians are trained in proper application of a cast. Some fractures may not be treated with a cast but it would not be appropriate to answer with this response because it does not reflect the actual reason for a splint being applied.
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? a) Apply ointment to the pin site. b) Scrubbing the drainage from around the pin site c) Applying iodine-based solution d) Obtaining a culture
Obtaining a culture Explanation: A culture should be obtained if purulent drainage is present. Drainage should be gently removed, not scrubbed. Iodine-based products interfere with tissue healing and are not recommended for cleaning pin sites. Ointment should not be applied to the pin site unless specifically ordered.
A 12-year-old client fractured her right leg several weeks ago while skiing and is returning to the orthopedist to have her cast removed. What would you expect the physician to prescribe as further treatment? a) Apply cold compresses to leg for swelling. b) No options are correct. c) Discontinue use of crutches. d) Physical therapy
Physical therapy Explanation: For some time, the limb will need support. An elastic bandage may be wrapped on a leg, the client may use a cane, and an arm may be kept in a sling until progressive active exercise and physical therapy help the client regain normal strength and motion.
Which nursing assessment finding indicates the client with traction has not met expected outcomes? a) Capillary refill < 3 seconds b) Repositions self with trapeze c) Right calf warm and swollen d) Peripheral pulses +2 bilaterally
Right calf warm and swollen Explanation: Deep vein thrombosis is a potential complication of the client immobilized by traction. Clinical manifestations of deep vein thrombosis include calf tenderness, warmth, redness, and swelling of the affected extremity.
A patient with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care? Select all that apply. a) Prepare for cast removal. b) Assess neurovascular status every 8 hours. c) Provide support to the injured extremity. d) Apply ice to extremity. e) Elevate the arm above the heart.
• Prepare for cast removal. • Provide support to the injured extremity. Explanation: The nurse should anticipate immediate removal of the cast and provide support to the injured extremity. Neurovascular status should be assessed more frequently than every 8 hours. If the patient is not showing improvement in the neurovascular status, then a fasciotomy may be needed. Waiting 8 hours to assess neurovascular status may cause permanent damage to the extremity. To promote arterial blood flow, the arm should be elevated to the heart level, not above. Ice should not be used as it could further decrease blood flow to the extremity.
The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery? a) Anticoagulation therapy b) Antidysrhythmia therapy c) Antianginal therapy d) Antineoplastic therapy
Anticoagulation therapy Explanation: Anticoagulation therapy and early ambulation are very important for clients who have knee or hip replacement to prevent thrombus formation. The other therapy is not indicated solely for the knee or hip arthroplasty.
Which of the following nursing actions would help prevent deep vein thrombosis in a patient who has had an orthopedic surgery? a) Instructing about exercise, as prescribed b) Instructing about using patient-controlled analgesia, if prescribed c) Applying cold packs d) Applying antiembolism stockings
Applying antiembolism stockings Explanation: Applying antiembolism stockings helps prevent deep vein thrombosis (DVT) in a patient who is immobilized due to orthopedic surgery. Regular administration of analgesics controls and prevents escalation of pain while ROM exercises help in maintaining muscle strength and tone and prevent contractions. On the other hand, cold packs are applied to help reduce swelling and this does not prevent deep vein thrombosis.
A 34-year-old client fractured his distal left radius while weight lifting. He returns to the emergency department, reporting discomfort at the cast site, with pain specifically in his upper forearm. What would you expect the physician to do? a) Remove the cast. b) Apply a fiberglass cast. c) Initiate physical therapy. d) Cut a cast window.
Cut a cast window. Explanation: After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing
After undergoing surgery the previous day for a total knee replacement, a client states that he doesn't feel ready to ambulate yet. What should the nurse do? a) Tell the client that she'll contact the physician and report his noncompliance. b) Document the client's refusal to ambulate. c) Discuss the complications that the client's may experience if he doesn't cooperate with the care plan. d) Do nothing because the client has the ultimate right to determine his degree of participation.
Discuss the complications that the client's may experience if he doesn't cooperate with the care plan. Explanation: The nurse should discuss the care plan and its rationale with the client. Calling the physician to report the client's noncompliance won't alter the client's degree of participation and shouldn't be used to force the client to comply. Doing nothing isn't acceptable. Although the client does have the right to make choices, it's the nurse's responsibility to provide education to help the client make informed decisions. Although the nurse should ultimately document the client's refusal, she should first discuss the care plan with the client.
The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which of the following complications? a) Dislocation of the hip b) Avascular necrosis of the hip c) Re-fracture of the hip d) Contracture of the hip
Dislocation of the hip Explanation: Manifestations of a dislocated hip prosthesis are increased pain at the surgical site, acute groin pain in the affected leg, shortening of the leg, abnormal external or internal rotation, and limited movement of the fractured leg. The client may report a "popping" sensation in the hip.
A patient with a fractured ankle is having a fiberglass cast applied. The patient starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate? a) Administer antianxiety and pain medication. b) Remove the cast immediately, notifying the physician. c) Explain that the sensation being felt is normal and will not cause burns to the patient. d) Call for assistance to hold the patient is the required position until the cast has dried.
Explain that the sensation being felt is normal and will not cause burns to the patient. Explanation: A fiberglass cast when applied will give off heat. The reaction is a normal, temporary sensation. Heat given off during the application phase of the cast does not cause burns to the skin. By explaining these principles to the patient, the nurse can alleviate any anxiety associated with the application of the cast. Because this is a known reaction to the application of the fiberglass cast, it is not necessary to remove the cast. Holding the patient may cause more harm to the injury. Antianxiety medications are generally not needed when applying a cast.
The nurse is preparing a client for a hip replacement with the use of porous-coated cementless joint components. What does the nurse know is the benefit of this type of component? a) It prevents the client from developing infection related to the application of cement in the joint spaces. b) The client will not reject the prosthesis because there is no cement on the prosthetics. c) The component is less expensive because there is no cement used. d) It allows the bone to grow into the prosthesis and securely fix the joint replacement in place.
It allows the bone to grow into the prosthesis and securely fix the joint replacement in place. Explanation: Porous-coated cementless joint components are used to allow the bone to grow into the prosthesis and thus securely fix the joint replacement in place. The prosthesis is not less expensive and cost is not a factor in reconstruction. The client may still have a local or systemic reaction to the prostheses even if it does not have cement.
A variety of complications can occur after a leg amputation. All of the following are possibilities in the immediate postoperative period, except? a) Hemorrhage b) Osteomyelitis c) Infection d) Hematoma
Osteomyelitis Explanation: Chronic osteomyelitis may occur after persistent infection in the late postoperative period. Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period.
A client is brought to the emergency department by a softball team member whostates the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize? a) Client complains of pain in the unaffected shoulder. b) Right shoulder is elevated above the left. c) Right shoulder slopes downward and droops inward. d) Client complains of tingling and numbness in the right shoulder.
Right shoulder slopes downward and droops inward. Explanation: The client with a fractured clavicle has restricted motion, and the affected shoulder appears to slope downward and droop inward. The client will have pain, not typically tingling and numbness in the right shoulder. Pain is not felt in the unaffected shoulder.
A client is about to have a cast applied to his left arm. The nurse would alert the client to which of the following as the cast is applied? a) Increased in pain in left arm b) Sensation of warmth or heat with application c) Arm being moved to various positions d) Sensation of weakness
Sensation of warmth or heat with application Explanation: When a cast is applied, the client needs to be aware that he may feel a sensation of warmth or heat due to the material being mixed with water. The client should not feel an increase in pain during the application. The arm will be held in place to ensure proper alignment during the application. The client should not feel weakness in the extremity. This is more commonly experiences after a cast is removed.
Which device is designed specifically to support and immobilize a body part in a desired position? a) Splint b) Traction c) Brace d) Sling
Splint Explanation: A splint may be applied to a fractured extremity initially until swelling subsides. A brace is an externally applied device to support a body part, control movement, and prevent injury. A sling is used to support an arm and traction is the use of a pulling force on a body part
Which of the following statements describes external fixation? a) The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. b) The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. c) The bone is surgically exposed and realigned. d) The bone is restored to its normal position by external manipulation.
The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. Explanation: In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. In internal fixation, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. In closed reduction, the bone is restored to its normal position by external manipulation. In open reduction, the bone is surgically exposed and realigned.
A patient with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which of the following is the priority action by the nurse? a) Reposition the patient for comfort. b) Teach relaxation techniques. c) Assess for previous opioid drug use. d) Assess for complications.
Assess for complications. Explanation: Unrelieved pain can be an indicator of a complication, such as, compartment syndrome. Previous opioid drug use should not influence a complete and thorough assessment. Repositioning the patient for comfort may be appropriate once all indications of a complication are ruled out. It is appropriate to teach relaxation techniques to help ease the pain, but assessing for a complication remains the highest priority.
