Chapter 41: Musculoskeletal - NCLEX

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

a) "My toes are stiff." Explanation: Compartment syndrome is characterized by neurovascular compromise. Stiffness of the toes may be a preliminary finding that the client is having trouble with motor function. pg.1107

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

d) 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. pg.1104

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) Teach the client how to prevent problems caused by immobility. c) Assess the client's level of consciousness. d) Remove the traction at least every 8 hours.

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. pg.1116

Which intervention should the nurse implement with the client who has undergone a hip replacement? a) Place the client in high Fowler's position for meals. b) Instruct the client to avoid internal rotation of the leg. c) Have the client bend forward to rise from the chair. d) Adduct the legs by placing a pillow between the legs.

b) 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. pg.1119

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

d) A fasciotomy Explanation: A treatment option for compartment is fasciotomy. pg.1107

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) Longer-lasting b) More breathable c) Quicker drying d) Better molding to the client

d) 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. pg.1104

Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure? a) Osteotomy b) Arthroplasty c) Arthrodesis d) Fasciotomy

d) 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. pg.1107

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? a) Pulleys without evidence of the obstruction b) Body aligned opposite to line of traction pull c) Ropes freely moving over pulleys d) Weights hanging and touching the floor

d) 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. pg.1112

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? a) Hypovolemia b) Atelectasis c) Pulmonary embolism d) Urinary tract infection

c) Pulmonary embolism Explanation: Patients having orthopedic surgery are particularly at risk for venous thromboembolism, including deep vein thrombosis and pulmonary embolism. pg.1118

A patient had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated? a) Diminished peripheral pulses on the affected extremity b) The leg length is the same as the right leg. c) The left leg is internally rotated. d) The patient has discomfort when moving in the bed.

c) The left leg is internally rotated. Explanation: The nurse must monitor for signs and symptoms of dislocation of the prosthesis, which include abnormal external or internal rotation of the affected extremity. pg.1123

All of the following are guidelines for avoiding hip dislocation after replacement surgery. Select the answer that is not. a) Put a pillow between the legs when sleeping. b) Keep the knees apart at all times. c) You may flex at the hip to put on clothing such as pants, stockings, socks, or shoes. d) Never cross the legs when seated.

c) 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. pg.1124

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) "When a spica cast is ordered, the arm must be immobilized." b) "This will allow for the strength in the arm to remain consistent." c) "The method will allow for the fastest healing time and the greatest mobility." d) "The joint above the fracture and below the fracture must be immobilized."

d) "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. pg.1103

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? a) Ensuring that the weights hang free at all times b) Keeping the client from sliding to the foot of the bed c) Keeping the ropes over the center of the pulley d) Assessing the extremity for neurovascular integrity

d) Assessing the extremity for neurovascular 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. pg.1114

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) Thomas splint b) Balanced suspension c) Crutchfield tongs d) Buck's

d) 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. pg.1113

A patient with an arm cast complains of pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? (Select all that apply.) a) Cut the cast with a cast saw b) Assess for a pressure sore c) Administer a prescribed analgesic to promote comfort and allay anxiety. d) Determine the exact site of the pain. e) Assess the fingers for color and temperature.

e) Assess the fingers for color and temperature. b) Assess for a pressure sore d) Determine the exact site of the pain. Explanation: Neurovascular assessment includes the assessment of peripheral circulation, motion, and sensation of the affected extremity, assessing the fingers or toes of the affected extremity, and comparing them with those of the opposite extremity. When assessing peripheral circulation, the nurse must check peripheral pulses as well as capillary refill response (within 3 seconds), edema, and the color and temperature of the skin. The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the patient to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale (see Chapter 12). Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer. pg.1105

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) "We will need to monitor the status of the laceration to be sure it does not get infected." b) "You will be able to wear the splint longer than you would a cast." c) "The splint is less expensive than the cast." d) "The arm does not require the same immobilization that a leg fracture would."

a) "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. pg.1105

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation? a) Abduction b) Adduction c) Internal rotation d) Flexion

a) Abduction Explanation: The nurse educates the patient about protective positioning, which includes maintaining abduction and avoiding internal and external rotation, hyperextension, and acute flexion. pg.1123

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 ineffective therapeutic regimen management b) Risk for avascular necrosis of the joint c) Disturbed body image d) Situational low self-esteem

a) 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. pg.1128

Upon reporting to work and receiving report, a nurse has been assigned to provide care for three clients. Each of the clients has called out to the nurses' station requesting assistance. Which client should the nurse see first? a) A 60-year-old female, who is in traction to manage chronic muscle spasms, who is requesting assistance to order her evening meal b) A 32-year-old male, who had a plaster cast applied to his leg 2 hours ago, who complains that the cast feels as if it's getting tighter c) The order doesn't matter; all clients are of equal priority d) A 56-year-old male, who had an arthroscopy of his left knee 3 hours ago, who is asking to be discharged

b) A 32-year-old male, who had a plaster cast applied to his leg 2 hours ago, who complains that the cast feels as if it's getting tighter Explanation: The male who reports his cast feels tighter requires a complete assessment that focuses on his neurovascular status. The nurse should respond to him first. The older male and female are stable and aren't priorities at this time. pg.1105

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) Neurovascular status b) Sleep status c) Cardiac status d) Renal function

a) 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. pg.1105

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) Reporting signs of impaired circulation b) Exercising joints above and below the cast, as ordered c) Using crutches properly d) Avoiding walking on a leg cast without the physician's permission

a) 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. pg.1109

Which of the following principles apply to the patient in traction? a) Skeletal traction is never interrupted b) Weights are removed routinely c) Weights should rest on the bed d) Knots in the ropes should touch the pulley

a) 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. pg.1114

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

b) 45 degrees onto the unoperated side if the affected hip is kept abducted Explanation: When the nurse turns the patient in bed to the unaffected side, it is important to keep the operative hip in abduction (movement away from the center or median line of the body). The patient should not be turned to the operative side, which could cause dislocation, unless specified by the surgeon. The patient's hip is never flexed more than 90 degrees. pg.1119

The nurse is taking care of a client who underwent a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity? Choose all correct options. a) Advise the client to place pillows between the legs. b) Advise the client to use a trochanter roll. c) Advise the client who is lying on the stomach to adduct the stump so it presses against the other leg. d) Advise the client to use antiembolism stockings on both legs.

b) Advise the client to use a trochanter roll. c) Advise the client who is lying on the stomach to adduct the stump so it presses against the other leg. Explanation: Use a trochanter roll to prevent external rotation of the hip and knee. Avoid placing pillows between the legs. These measures prevent abduction deformity. If the client is lying on the stomach, the nurse should advise the client to adduct the stump so it presses against the other leg. Adduction stretches flexor muscles and prevents abduction deformity. The client should only use an antiembolism stocking on the unaffected leg. pg.1189

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) Heart rate of 94 beats/minute b) Crackles in the lung bases c) Blood pressure of 140/90 mm Hg d) Client complains of pain in the affected rib area when taking a deep breath

b) 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. pg.1182

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) Remove the cast immediately, notifying the physician. b) Explain that the sensation being felt is normal and will not cause burns to the patient. c) Call for assistance to hold the patient is the required position until the cast has dried. d) Administer antianxiety and pain medication.

b) 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. pg.1104

The nurse is very concerned about the potential debilitating complication of peroneal nerve injury. What symptom does the nurse recognize as a result of that complication? a) Permanent paresthesias b) Footdrop c) Deep vein thrombosis (DVT) d) Infection

b) Footdrop Explanation: Injury to the peroneal nerve as a result of pressure is a cause of footdrop (the inability to maintain the foot in a normally flexed position). Consequently, the patient drags the foot when ambulating. pg.1109

A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. The nurse identifies this as which type of cast? a) Body cast b) Gauntlet cast c) Short arm cast d) Spica cast

b) Gauntlet cast Explanation: A gauntlet cast is a short arm cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb, with the thumb also being casted. A short arm cast extends from below the elbow to the palmar crease and is secured around the base of the thumb. A body cast is a larger form of a cylinder cast that encircles the trunk from about the nipple line to the iliac crests. A hip spica cast surrounds one or both legs and the trunk. It may be strengthened by a bar that spans a casted area between the legs. pg.1104

The nurse teaches the patient which of the following interventions in order to avoid hip dislocation after replacement surgery? a) Bend forward only when seated in a chair. b) Never cross the affected leg when seated. c) Keep the knees together at all times. d) Avoid placing a pillow between the legs when sleeping.

b) 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. pg.1119

A patient has a long leg cast applied. Where does the nurse understand a common pressure problem may occur? a) Dorsalis pedis b) Peroneal nerve c) Popliteal artery d) Posterior tibialis

b) Peroneal nerve Explanation: The nurse assesses circulation by observing the color, temperature, and capillary refill of the exposed toes. Nerve function is assessed by observing the patient's ability to move the toes and by asking about the sensations in the foot. Numbness, tingling, and burning may indicate peroneal nerve injury resulting from pressure at the head of the fibula. pg.1109

Which of the following devices is designed specifically to support and immobilize a body part in a desired position? a) Trapeze b) Splint c) Continuous passive motion (CPM) device d) Brace

b) 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 CPM device is an instrument that moves a body part to promote healing and circulation. A trapeze is an overhead device to promote patient mobility in bed. pg.1105

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? a) "Monitoring skin integrity is important while the continuous passive motion device is in place." b) "The continuous passive motion device can decrease the development of adhesions." c) "The client is receiving physical therapy twice per day, so he doesn't need a continuous passive motion device." d) "Bleeding is a complication associated with the continuous passive motion device."

c) "The client is receiving physical therapy twice per day, so he doesn't need a continuous passive motion device." Explanation: Further staff education is needed when the nurse states that the continuous passive motion device isn't needed because the client receives physical therapy twice per day. The continuous passive motion device should be used in conjunction with physical therapy because the device helps prevent adhesions. Bleeding is a complication associated with the continuous passive motion device; skin integrity should be monitored while the device is in use. pg.1126

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) Minimal pain in the left arm b) Cast edges are rough, with skin irritation present c) Fingers on the left hand are swollen and cool d) Presence of a normal popliteal pulse

c) 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. pg.1109

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) Cut a cast window. b) Initiate physical therapy. c) Remove the cast. d) Apply a fiberglass cast.

a) 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. pg.1108

A client is brought to the emergency department by a softball team member who states 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) Right shoulder slopes downward and droops inward. b) Client complains of pain in the unaffected shoulder. c) Right shoulder is elevated above the left. d) Client complains of tingling and numbness in the right shoulder.

a) 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. pg.1184

Meniscectomy refers to the a) replacement of one of the articular surfaces of a joint. b) excision of damaged joint fibrocartilage. c) incision and diversion of the muscle fascia. d) removal of a body part.

b) 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. pg.1116

A nurse would most likely expect the need for open reduction for a client with which of the following? a) Little bone separation b) Soft tissue free of bone ends c) Joint fracture d) Closed fracture

c) Joint fracture Explanation: An open reduction is required when soft tissue is caught between the ends of the broken pieces of bone, the bone has a wide separation, open fractures are evident, comminuted fractures are present, and the patella or other joints are fractured. It is also done when wound debridement or internal fixation is needed. pg.1116

Which of the following is an inaccurate principle of traction? a) The weights are not removed unless intermittent treatment is prescribed. b) The patient must be in good alignment in the center of the bed. c) Skeletal traction is interrupted to turn and reposition the patient. d) The weights must hang freely.

c) 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. pg.1114

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) Atelectasis c) Urinary retention d) Hypovolemic shock

d) 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. pg.1128

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) Antianginal therapy c) Antineoplastic therapy d) Antidysrhythmia therapy

a) 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. pg.1118

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

a) 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. pg.1108

Which of the following nursing actions would help prevent deep vein thrombosis in a patient who has had an orthopedic surgery? a) Applying antiembolism stockings b) Applying cold packs c) Instructing about exercise, as prescribed d) Instructing about using patient-controlled analgesia, if prescribed

a) 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. pg.56

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) Assess for complications. b) Teach relaxation techniques. c) Reposition the patient for comfort. d) Assess for previous opioid drug use.

a) 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. pg.10

The nurse is assigned to care for a client who has had an open reduction and internal fixation of a fractured right femur 2 days ago. The nurse is listening to the client's lungs and, when moving the gown, observes petechial hemorrhages on the skin of the chest. What is the first action by the nurse? a) Call the physician to inform them of the findings. b) Increase the intravenous fluids for hemorrhage. c) Request an antihistamine for the allergic reaction. d) Administer pain medication.

a) Call the physician to inform them of the findings. Explanation: The findings of the nurse indicate that the client may have a fat embolus, and the physician should be informed immediately. Administration of pain medication is not indicated at this time. The rash is not indicative of an allergic reaction. There is no indication that the rash is related to hemorrhage, and there is no need to increase the IV fluids. pg.1164

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) Changing the client's position within prescribed limits. b) Assisting with range-of-motion and isometric exercises. c) Applying warm compresses. d) Administering prescribed analgesics.

a) 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. pg.1113

Which action by the nurse would be inappropriate for the client following casting? a) Circulate room air with a portable fan. b) Petal and smooth the edges of the cast. c) Protect the cast by covering with a sheet. d) Handle the cast with the palms of hands.

c) 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. pg.1104

Which would be consistent as a component of self-care activities for the patient with a cast? a) Cushioning rough edges of the cast with tape b) Use plastic hanger wrapped in gauze to scratch under the cast. c) Place the casted extremity in a dependent position frequently d) Cover the cast with plastic to insulate it

a) Cushioning rough edges of the cast with tape Explanation: The patient can cushion rough edges with tape to prevent skin irritation. 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 casted extremity is to be elevated to heart level frequently; a dependent position will increase swelling. A patient should not use any object to scratch under the cast. pg.1108

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

a) 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. pg.1119

Which of the following definitions describes the hip spica cast? a) Encloses the trunk and a lower extremity b) A short or long leg cast reinforced for strength c) Encircles the trunk d) 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.

a) 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. pg.1104

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.) a) Excruciating pain b) Capillary refill less than 3 seconds c) Decreased sensory function d) Loss of motion e) 2+ peripheral pulses in the affected distal pulse

a) Excruciating pain c) Decreased sensory function d) Loss of motion Explanation: Clinical manifestations include dusky, pale appearance of the exposed extremity; cool skin temperature; delayed capillary refill; paresthesia; and unrelenting pain not relieved by position changes, ice, or analgesia. A hallmark sign is pain that occurs or intensifies with passive range of motion (Johnston-Walker & Hardcastle, 2011). The patient may complain that the cast, brace, or splint is too tight. The primary provider must be notified immediately. pg.1107

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) Exploring factors related to the client's home environment b) Educating the client about the effects of menopause c) Urging her to keep the affected limb in an elevated position d) Advising the client to avoid red meat

a) 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. Because the healing is almost complete, the client need not always keep the affected limb elevated unless prescribed to do so. Because 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. pg.1123

Of the definitions for surgical procedures to correct joint deformities listed as follows, which describes arthrodesis? a) Fusion of a joint (most often the wrist or knee) for stabilization and pain relief b) Total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain c) The replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum d) 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

a) Fusion of a joint (most often the wrist or knee) for stabilization and pain relief Explanation: Arthrodesis is fusion of a joint (most often the wrist or knee) for stabilization and pain relief. Arthroplasty is total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain. Hemiarthroplasty is the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. Osteotomy is the 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. pg.1140

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) Increase calorie intake. c) Reduce fluid intake. d) Remove the weights during linen changes.

a) 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. pg.1116

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) Impaired Physical Mobility related to traction d) Activity Intolerance related to impaired mobility

a) Ineffective Coping related to prolonged immobility Explanation: The client is displaying clinical manifestations of anxiety and ineffective coping. pg.1115

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 arthroplasty b) Open reduction and internal fixation of the left hip. c) Closed reduction of the left hip. d) Left hip arthroscopy

a) 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. pg.1116

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) Maintaining adequate circulation b) Ensuring there wasn't nerve damage during surgery c) Making sure surgery was successful d) Typical postoperative nursing management

a) 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. pg.1121

The client with a newly applied cast complains of severe unrelenting pain. Which of the following nursing actions should the nurse do next? a) Make the client NPO and notify the physician. b) Loosen the edges of the cast and elevate the leg. c) Reposition the extremity for comfort and apply ice. d) Administer a dose of morphine sulfate.

a) Make the client NPO and notify the physician. Explanation: The client is exhibiting symptoms of compartment syndrome. The physician needs to be contacted as treatment options include bivalving of the cast or a possible fasciotomy, a surgical procedure. pg.1107

A variety of complications can occur after a leg amputation. All of the following are possibilities in the immediate postoperative period, except? a) Osteomyelitis b) Hematoma c) Hemorrhage d) Infection

a) 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. pg.1186

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) Sensation of warmth or heat with application b) Sensation of weakness c) Arm being moved to various positions d) Increased in pain in left arm

a) 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. pg.1104

Which of the following would be an inconsistent initial pain relief measure for the patient with a cast? a) Application of cold packs b) Application of a new cast c) Administration of analgesics d) Elevation of the involved part

b) 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. pg.1106

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

b) 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. pg.1128

Which nursing assessment finding would be indicative of compartment syndrome in the client with a cast applied to the left forearm 3 hours earlier? a) Absence of numbness and tingling b) Capillary refill of left fingers greater than 3 seconds c) Radial pulses palpable and +2 bilaterally d) Fingers pink and warm and move freely

b) Capillary refill of left fingers greater than 3 seconds Explanation: Compartment syndrome is characterized by neurovascular compromise. Capillary refill should be less than 3 seconds. pg.1107

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) Encourage client to do ROM exercises as indicated. b) Elevate the affected extremity and use cold applications. c) Apply antiembolism stockings as indicated. d) Instruct client to deep breathe and cough every 2 hours until he can ambulate.

b) 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). pg.1105

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

b) Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. Explanation: The nurse should assess for pain on passive flexion of each foot, which could indicate deep vein thrombosis. pg.1121

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) Promote elimination with a regular bedpan. d) Position the client on the affected side.

b) 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. pg.1110

A client is in Buck's traction after fracturing his right hip. The nurse should include which action in the care plan? a) Keeping the client in semi-Fowler's position b) Maintaining correct body alignment c) Maintaining the bed in the knee-Gatch position d) Removing the weights once every shift

b) Maintaining correct body alignment Explanation: Buck's traction produces realignment by exerting a pulling force on the fractured hip. Therefore, the nurse must maintain correct body alignment. Traction should be continuous; if the weights must be removed, the nurse should apply manual traction until the weights are replaced. The nurse shouldn't use the knee-Gatch position because it disrupts the constant pulling force needed for alignment. Using the semi-Fowler's position would cause the client to slide in the direction of the traction, defeating the purpose of traction. pg.1112

The nurse assesses a patient after total right hip arthroplasty and observes a shortening of the extremity, and the patient complains of severe pain in the right side of the groin. What is the priority action of the nurse? a) Apply Buck's traction. b) Notify the physician. c) Externally rotate the extremity. d) Bend the knee and rotate the knee internally.

b) Notify the physician. Explanation: If any clinical manifestations of dislocation of the prosthesis occur, including acute groin pain in the affected hip or shortening of the affected extremity, the nurse (or the patient, if at home) must immediately notify the surgeon, because the hip must be reduced and stabilized promptly so that the leg does not sustain circulatory and nerve damage. After closed reduction, the hip may be stabilized with Buck's traction or a brace to prevent recurrent dislocation. As the muscles and joint capsule heal, the chance of dislocation diminishes. Stresses to the new hip joint should be avoided for the first 8 to 12 weeks, when the risk of dislocation is greatest. pg.1123

A client's fracture was reduced by surgically exposing the bone and realigning it. The nurse identifies this as which of the following? a) Internal fixation b) Open reduction c) Buck's traction d) Skeletal traction

b) 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. pg.1116

A patient is placed in traction for a femur facture. The nurse would document what as the expected outcomes of traction? Select all that apply. a) Full range of motion to extremity b) Reduction of deformity c) Minimization of muscle spasms d) Realignment of a fracture e) Increased ability to bear weight f) Decreased pedal pulse

b) Reduction of deformity c) Minimization of muscle spasms d) Realignment of a fracture Explanation: Traction is used to minimize muscle spasms, to reduce, align, and immobilize fractures, and to reduce deformity. Traction does not allow for full range of motion or an increased ability to bear weight. The patient is confined to the bed while in traction. A decreased pulse is a sign of circulatory compromise and should be investigated and reported. pg.1111

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Which intervention would be inappropriate for the prophylactic treatment of deep vein thrombosis? a) antiembolic stockings b) increased fiber intake c) enoxaparin (Lovenox) d) increased fluid intake

b) increased fiber intake Explanation: Increased fiber intake does not prevent deep vein thrombosis. pg.1118

A nurse is caring for a client who recently underwent a total hip replacement. The nurse should: a) ease the client onto a low toilet seat. b) limit hip flexion of the client's hip when he sits. c) use soft chairs when the client is sitting out of bed. d) allow the client's legs to be crossed at the knees when out of bed.

b) limit hip flexion of the client's hip when he sits. Explanation: The nurse should instruct the client to limit hip flexion to 90 degrees when he sits. The nurse should supply an elevated toilet seat so that the client can sit without having to flex his hip more than 90 degrees. The nurse should instruct the client not to cross his legs to avoid dislodging or dislocating the prosthesis. The nurse should caution the client against sitting in chairs that are too low or too soft; these chairs increase flexion, which is undesirable. pg.1119

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 delivers analgesic agents directly into the joint." b) "CPM strengthens the muscles of the leg." c) "CPM increases range of motion of the joint." d) "CPM prevents injury by limiting flexion of the knee."

c) "CPM increases range of motion of the joint." Explanation: CPM increases circulation and range of motion of the knee joint. pg.1126

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."

c) "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. pg.1119

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) "A belt will go around my pelvis and weights will be attached." b) "I will wear a boot with weights attached." c) "Metal pins will go through my skin to the bone." d) "The traction can be removed once a day so I can shower."

c) "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. pg.1114

Which of the following nursing actions would help prevent deep vein thrombosis in a patient who has had an orthopedic surgery? a) Apply cold packs b) Instruct about exercise, as prescribed c) Apply antiembolism stockings d) Instruct about using patient-controlled analgesia, if prescribed

c) Apply 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 it does not prevent deep vein thrombosis. pg.1128

A client has a Fiberglas cast on the right arm. Which action should the nurse include in the care plan? a) Evaluating pedal and posterior tibial pulses every 2 hours b) Avoiding handling the cast for 24 hours or until it is dry c) Assessing movement and sensation in the fingers of the right hand d) Keeping the casted arm warm by covering it with a light blanket

c) 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. pg.1109

Which type of cast encloses the trunk and a lower extremity? a) Short-leg b) Body cast c) Hip spica d) Long-leg

c) 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. pg.1109

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 promotes healing by immobilizing the knee joint. c) It promotes healing by increasing circulation and movement of the knee joint. d) It provides active range of motion.

c) 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. pg.1113

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) Surgery will not be required. b) The bones of the left leg will be aligned. c) Muscle spasms will be relieved. d) Less pain medication will be required. e) Immobilization of the left leg will be maintained.

c) Muscle spasms will be relieved. b) The bones of the left leg will be aligned. e) Immobilization of the left leg will be maintained. 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. pg.1111

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? a) Long leg cast b) Hip spica cast c) Short leg cast d) Walking cast

c) Short leg cast Explanation: A short leg cast extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. 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. A walking cast is a short or long leg cast reinforced for strength. A hip spica cast encloses the trunk and a lower extremity. pg.1104

Which of the following would the nurse expect a physician to use on a short-term basis for a client with an injured body part that does not require rigid immobilization? a) Cast b) Brace c) Splint d) Skin traction

c) Splint Explanation: A splint immobilizes and supports an injured body part in a functional position and is used when the condition does not require rigid immobilization, causes a large degree of swelling, or requires special skin treatment. Casts and traction provide rigid immobilization. A brace provides support, controls movement, and prevents additional injury for more long-term use. pg.1105

Which of the following statements describes external fixation? a) The bone is surgically exposed and realigned. b) The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. c) The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. d) The bone is restored to its normal position by external manipulation.

c) 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. pg.1110

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) Hemiarthroplasty c) Total arthroplasty d) Osteotomy

c) 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. pg.1116

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) Abduction and adduction of the shoulder c) Use of isometric exercises d) Repositioning the arm in the cast

c) 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. pg.1108

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) "You would have to stay here much longer because it takes a cast longer to dry." d) "A splint is applied when more swelling is expected at the site of injury."

d) "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. pg.1105

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) Elevate the casted extremity to heart level frequently c) Do not attempt to scratch the skin under a cast d) Cover the cast with plastic to insulate it

d) 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. pg.1104

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) Insertion of an external fixator b) Removal of the cast c) Cutting of a bivalve cast d) Cutting a cast window

d) 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. pg.1108

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) Notify the physician. b) Assess patient's hemoglobin and hematocrit. c) Prepare for surgical removal of the fixator. d) Document the findings.

d) 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. pg.1111

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) Chronic osteomyelitis b) Neuroma c) Unexplainable burning pain (causalgia) d) Hematoma

d) 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. pg.1187

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) The component is less expensive because there is no cement used. b) It prevents the client from developing infection related to the application of cement in the joint spaces. c) The client will not reject the prosthesis because there is no cement on the prosthetics. d) It allows the bone to grow into the prosthesis and securely fix the joint replacement in place.

d) 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. pg.1117

A client has undergone an external fixation. Which actions would be the priority for this client? a) Monitoring the client's blood pressure. b) Monitoring the client's urine output. c) Planning the client's diet. d) Maintaining pin care.

d) Maintaining pin care. 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. pg.1110

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority? a) Monitoring the client for skin breakdown b) Supporting the traction weights with a chair or table to prevent accidental slippage c) Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use d) Maintaining traction continuously to ensure its effectiveness

d) 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. pg.1114

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) a) "Avoid bending forward when sitting in a chair." 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) "It is okay to briefly flex the hip to put on your clothes."

d) Place pillows between your legs when you lay on your side." a) "Avoid bending forward when sitting in a chair." b) "Use a raised toilet seat and high-seated 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. pg.1119

Which nursing assessment finding indicates the client with traction has not met expected outcomes? a) Capillary refill < 3 seconds b) Peripheral pulses +2 bilaterally c) Repositions self with trapeze d) Right calf warm and swollen

d) 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. pg.1118

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

d) Sharp and piercing Explanation: The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the patient to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale. Most pain can be relieved by elevating the involved part, applying ice or cold packs, and administering analgesic agents as prescribed. Pain associated with the underlying condition (e.g., fracture, which is sharp and piercing) is frequently controlled by immobilization. Pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can frequently be controlled by elevation and, if prescribed, intermittent application of ice or cold packs. Ice bags (one third to one half full) or cold application devices are placed on each side of the cast, if prescribed, making sure not to indent or wet the cast. Unrelieved or disproportionate pain may indicate complications. Pain associated with compartment syndrome is relentless and is not controlled by modalities such as elevation, application of ice or cold, and usual dosages of analgesic agents. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer. This may also occur from too-tight elastic wraps used to hold splints in place. pg.1106

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 leg will look as it did prior to the cast being applied. b) The leg strength is enforced by the wearing of the cast. c) The leg will look moist and will have small bumps that will go away in a few days. d) The skin may be covered with a yellowish crust that will shed in a few days.

d) 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. pg.1108