Ch. 62 & 63 Prep U
A 39-year-old softball player has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would you expect the physician to perform?
Joint manipulation and immobilization
A nurse is preparing to discharge a patient from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage which of the following?
Keep an elastic compression bandage on the ankle.
Which of the following is an inaccurate clinical manifestation of a fracture?
Lengthening
Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis?
Leukocytosis and localized bone pain
Which of the following terms refers to failure of fragments of a fractured bone to heal together?
Nonunion
A patient with diabetes has been diagnosed with osteomyelitis. The nurse notes that the patient's right foot is pale and mottled, cool to touch, with a capillary refill of greater than 3 seconds. The nurse should suspect what type of osteomyelitis?
Osteomyelitis with vascular insufficiency
Which of the following is a hallmark sign of compartment syndrome?
Pain
A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?
"Apply ice packs for the first 24 to 48 hours, then apply heat packs."
A nurse is writing a care plan for a patient admitted to the emergency department (ED) with an open fracture. The nurse will assign priority to what nursing diagnosis for a patient with an open fracture of the radius?
Risk for Infection
Which nursing diagnosis takes highest priority for a client with a compound fracture?
Risk for infection related to effects of trauma
After a bone breaks, the muscles surrounding the bone go from being flaccid to going into spasm, often increasing the deformity and interfering with the vascular and lymphatic circulations. Tissue around the fracture swells from hemorrhage and edema. Healing begins when blood in the area clots, and a fibrin network forms between the broken bone ends. How long does it take for the bone to regain its former structural strength after a break?
1 year
The surgical nurse is admitting a patient from postanesthetic recovery following the patient's below-the-knee amputation. The nurse recognizes the patient's high risk for postoperative hemorrhage and should keep which of the following at the bedside?
A tourniquet
When is it advisable for the nurse to apply heat to a sprain or a contusion?
After 2 days
When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction?
Apply ice to the fracture site.
A patient diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. In responding to the patient, how would the nurse best describe CTS?
"CTS is a neuropathy that is characterized by compression of the median nerve at the wrist."
A patient asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse?
"Elevating the leg might lead to a flexion contracture."
A patient is undergoing diagnostic testing to determine the etiology of recent joint pain. The patient asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse?
"OA is a considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."
There are a variety of problems that can become complications after a fracture. Which of the following is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head?
Avascular necrosis
A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?
Between 24 and 48 hours
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication?
Bone fracture
An elderly female with osteoporosis has been hospitalized. Prior to discharge, when teaching the patient, the nurse should include information about which major complication of osteoporosis?
Bone fracture
An x-ray demonstrates a fracture in which a bone has splintered into several pieces, which type of fracture is this?
Comminuted
A 35-year-old client is visiting a rheumatology group practice. The client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications?
Common adverse effects
Which of the following is a term used to describe a soft tissue injury produced by a blunt force?
Contusion
A 39-year-old client has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicated intact but malpositioned bones, what would you expect the physician to diagnose?
Dislocation
A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?
Keeping a pillow between the client's legs at all times
Which of the following surgical procedures may need to be done when removing a cast or bandage does not restore circulation to the extremity?
Fasciotomy
After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?
Fat embolism
A nurse is performing a shift assessment on an elderly patient who is recovering after surgery for a hip fracture. The nurse notes that the patient is complaining of chest pain, has an increased heart rate, and increased respiratory rate. The nurse further notes that the patient is febrile and hypoxic, coughing, and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this patient is likely demonstrating symptoms of what complication?
Fat embolism syndrome
Which of the following terms refers to a break in the continuity of a bone?
Fracture
The type of fracture described as having one side of the bone broken and the other side bent would be
Greenstick
A 78-year-old client is in the emergency department following involvement in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of her upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma?
Immobilization
A nurse is caring for a patient who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the patient does which of the following in order to prevent common complications associated with a hip fracture?
Increase fluid intake and perform prescribed foot exercises.
A patient suffered an open fracture to the left femur during a horse-riding accident. For which of the following complications is this patient at highest risk?
Infection
A patient who has undergone a lower limb amputation is preparing to be discharged home. What outcome is necessary prior to discharge?
Patient can demonstrate safe use of assistive devices.
A patient with a traumatic amputation of the right lower leg is refusing to look at the leg. Which of the following actions by the nurse is most appropriate?
Provide feedback on the patient's strengths and available resources.
A 19-year-old patient presents to the emergency room with an injury to her left ankle that occurred during a high school basketball game. She complains of limited motion and pain on walking, which increased over the last 2 hours. The nurse knows that her diagnosis is most likely which of the following?
Second-degree sprain
When joint manipulation is unsuccessful for a client, he is taken to surgery for surgical repair of his hip injury. He is brought to the ICU where you practice nursing for postoperative recovery. After surgery, the nurse implements measures to prevent complications. Select all of the following which are complications that the nurse seeks to prevent.
Skin breakdown Wound infection Pneumonia
Which type of fracture is one in which the skin or mucous membranes extends to the fractured bone?
Compound
A 13-year-old client is brought to the emergency department. The client's mother reports that the client was struck with a baseball bat on his upper arm while diving for a pitched ball. After diagnostic tests are completed, the physician reassures the mother that her son's humerus is not broken but he has suffered another type of injury. What type of injury would you expect the physician to diagnose?
Contusion
When joint manipulation is unsuccessful for a client, he is taken to surgery for surgical repair of his hip injury. He is brought to the ICU where you practice nursing for postoperative recovery. In addition to the regular assessments prescribed by policy, what assessment is completed every 30 minutes for several hours?
Neurovascular
Which of the following terms refers to an injury to ligaments and other soft tissues of a joint?
Sprain
Most cases of osteomyelitis are caused by which of the following microorganisms?
Staphylococcus
A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include:
inability to perform active movement and pain with passive movement.
Which of the following is a factor that inhibits fracture healing?
History of diabetes
What intervention is a priority for a patient diagnosed with osteoarthritis?
Physical therapy and exercise
A nurse is caring for a client with an intracapsular hip fracture. Identify the area where this client's fracture occurred.
Place X on the ball of the bone
Which of the following is the most appropriate nursing intervention to facilitate healing in a patient who has suffered a hip fracture?
Place a pillow between the patient's legs when turning.
A patient was fitted with an arm cast after fracturing her humerus. Twelve hours after the application of the cast, the patient tells the nurse that her arm hurts. Analgesics do not relieve the pain. What would be the most appropriate nursing action?
Prepare the patient for opening or bivalving of the cast.
Which assessment findings would cause the nurse to suspect compartment syndrome after casting of the leg?
Complaints of numbness and tingling in toes of affected leg
Which nursing intervention is appropriate for a patient with a closed reduction extremity fracture?
Encouraging participation in ADLs
A patient with a simple arm fracture is receiving discharge education from the nurse. What would the nurse instruct the patient to do?
Engage in exercises that strengthen the unaffected muscles.
Which of the following terms refers to a fracture in which one side of a bone is broken and the other side is bent?
Greenstick
Which nursing intervention is essential in caring for a client with compartment syndrome?
Removing all external sources of pressure, such as clothing and jewelry
The RICE acronym is helpful for remembering treatment interventions for musculoskeletal injuries. Which of the following are components of the RICE acronym? Select all that apply.
Rest Ice Compression Elevation
After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?
With the leg on the affected side abducted
A nurse advises a patient with a casted femur fracture to check for signs of a fat embolism. She tells the patient that the onset of symptoms for FES occur:
Within 12 to 48 hours.
A client has fractured her femur and is being seen in the emergency department. As you are assessing the area, you notice there is a grating sound that you suspect is bone ends moving over one another. What would this be called?
Crepitus
A client presents to the emergency department gently holding the left arm, which is slightly swollen and painful to the touch. Based on these findings, the nurse:
Elevates the arm and applies an ice pack
A nurse is caring for a patient who has suffered an unstable thoracolumbar fracture. Which of the following is the priority during nursing care?
Maintaining spinal alignment
A patient has sustained a long bone fracture and the nurse is preparing the patient's care plan. Which of the following should the nurse include in the care plan?
Monitor temperature and pulses of the affected extremity.
A patient complains of pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The patient was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury?
Sprain
