Chapter 41-43
Which type of fracture involves a break through only part of the cross-section of the bone? a) Incomplete b) Comminuted c) Oblique d) Open
a) Incomplete An incomplete fracture involves a break through only part of the cross-section of the bone. A comminuted fracture is one that produces several bone fragments. An open fracture is one in which the skin or mucous membrane wound extends to the fractured bone. An oblique fracture runs across the bone at a diagonal angle of 45 to 60 degrees.
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? a) "Apply heat packs for the first 24 to 48 hours." b) "Apply ice packs for the first 24 to 48 hours, then apply heat packs." c) "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours." d) "Apply ice packs for the first 12 to 18 hours."
b) "Apply ice packs for the first 24 to 48 hours, then apply heat packs." The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.
What instructions should the nurse include in the discharge teaching for the client following an arthroscopy? a) "It is normal to feel hot spots over the puncture site." b) "The pain should be well-controlled with Tylenol." c) "Keep the leg in the dependent position as much as possible." d) "Numbness and tingling in the foot are expected the first 24 hours."
b) "The pain should be well-controlled with Tylenol." Mild analgesics are sufficient for pain control. The leg should be elevated with ice applied. The client should be taught the signs and symptoms of infection (such as heat) and neurovascular compromise (such as numbness and tingling) and instructed to contact the physician if they occur.
Which group is at the greatest risk for osteoporosis? a) African American women b) Caucasian women c) Asian women d) Men
b) Caucasian women Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Asian women of slight build are at risk for low peak BMD. African American women, who have a greater bone mass that Caucasian women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.
A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan? a) Removing the pressure dressing after the first 8 hours b) Elevating the stump for the first 24 hours c) Applying heat to the stump as the client desires d) Maintaining the client on complete bed rest
b) Elevating the stump for the first 24 hours Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. Bed rest isn't indicated and could predispose the client to complications of immobility. Heat application would be inappropriate because it promotes vasodilation, which may cause hemorrhage and increase pain. The initial pressure dressing usually remains in place for 48 to 72 hours after surgery.
Which action by the nurse would be inappropriate for the client following casting? a) Circulate room air with a portable fan. b) Protect the cast by covering with a sheet. c) Handle the cast with the palms of hands. d) Petal and smooth the edges of the cast.
b) Protect the cast by covering with a sheet. 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 patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing? a) Vitamin supplements b) Surgical debridement c) Wound packing d) Wound irrigation
b) Surgical debridement In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.
Which discharge instruction should a nurse give a client who's had surgery to repair a hip fracture? a) "Don't flex your hip more than 60 degrees, don't cross your legs, and have someone help you put your shoes on." b) "Don't flex your hip more than 30 degrees, don't cross your legs, and have someone help you put your shoes on." c) "Don't flex your hip more than 90 degrees, don't cross your legs, and have someone help you put your shoes on." d) "Don't flex your hip more than 120 degrees, don't cross your legs, and have someone help you put your shoes on."
c) "Don't flex your hip more than 90 degrees, don't cross your legs, and have someone help you put your shoes on." Falls in the home cause most injuries among the elderly. Elderly clients should take measures to decrease the clutter that can contribute to falls, such as removing objects such as throw rugs from the floor. Elderly clients should also install grab bars in the shower and next to the toilet. The threat of fire makes burglar bars on every window impractical.
Which of the following would be inconsistent as a component of self-care activities for the patient with a cast? a) Cushioning rough edges of the cast with tape b) Do not attempt to scratch the skin under a cast c) Cover the cast with plastic to insulate it d) Elevate the casted extremity to heart level frequently
c) Cover the cast with plastic to insulate it 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.
Which of the following would lead a nurse to suspect that a client has a rotator cuff tear? a) Minimal pain with movement b) Pain worse in the morning c) Increased ability to stretch arm over the head d) Difficulty lying on affected side
d) Difficulty lying on affected side Clients with a rotator cuff tear experience pain with movement and limited mobility of the shoulder and arm. They especially have difficulty with activities that involve stretching their arm above their head. Many clients find that the pain is worse at night and that they are unable to sleep on the affected side.
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) Avascular necrosis of the hip b) Re-fracture of the hip c) Contracture of the hip d) Dislocation of the hip
d) Dislocation of the hip 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.
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? a) Thoracic b) Upper lumbar c) Cervical d) Lower lumbar
d) Lower lumbar The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes.
Which intervention should the nurse implement, when caring for the client who complains of phantom limb pain two months after amputation? a) Assess the stump for signs and symptoms of bleeding. b) Reposition the stump, elevating it on two pillows. c) Assess the stump for signs and symptoms of infection. d) Reassure the client that phantom pain is common.
d) Reassure the client that phantom pain is common. The nurse acknowledges the client's complaints of pain.
