Chapter 62: Musculoskeletal Trauma and Orthopedic Surgery ANS

After the health care provider has recommended amputation for a patient who has nonhealing ischemic foot ulcers, the patient tells the nurse that he would rather die than have an amputation. Which response by the nurse is best?

"Tell me what you know about your options for treatment."

A factory line worker has repetitive strain syndrome in the left elbow. The nurse will plan to teach the patient about

modifying arm movements.

A patient who arrives at the emergency department experiencing severe left knee pain is diagnosed with a patellar dislocation. The initial patient teaching by the nurse will focus on the need for

monitored anesthesia care.

The occupational health nurse will teach the patient whose job involves many hours of typing about the need to

obtain a keyboard pad to support the wrist.

The nurse is caring for a patient who is to be discharged from the hospital 5 days after insertion of a femoral head prosthesis using a posterior approach. Which statement by the patient indicates a need for additional instruction?

"I can sleep in any position that is comfortable for me."

Which statement by a 62-year-old patient who has had an above-the-knee amputation indicates that the nurse's discharge teaching has been effective?

"I should lay flat on my abdomen for 30 minutes 3 or 4 times a day."

Which statement by the patient indicates a good understanding of the nurse's teaching about a new short-arm plaster cast?

"I will apply an ice pack to the cast over the fracture site off and on for 24 hours."

A high school teacher with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for a left hand arthroplasty. Which patient statement to the nurse indicates a realistic expectation for the surgery?

"I will be able to use my fingers with more flexibility to grasp things."

A patient who is to have no weight bearing on the left leg is learning to walk using crutches. Which observation by the nurse indicates that the patient can safely ambulate independently?

The patient advances the left leg and both crutches together and then advances the right leg.

A patient is being discharged 4 days after hip replacement surgery using the posterior approach. Which patient action requires immediate intervention by the nurse?

The patient leans over to pull shoes and socks on.

A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which nursing assessment finding is important to report to the health care provider?

Abdomen is distended and bowel sounds are absent.

The day after a having a right below-the-knee amputation, a patient complains of pain in the right foot. Which action is best for the nurse to take?

Administer prescribed analgesics to relieve the pain.

Before assisting a patient with ambulation 2 days after a total hip replacement, which action is most important for the nurse to take?

Administer the ordered oral opioid pain medication.

When teaching seniors at a community recreation center, which information will the nurse include about ways to prevent fractures?

Buy shoes that provide good support and are comfortable to wear.

A 32-year-old patient who has had an open reduction and internal fixation (ORIF) of left lower leg fractures continues to complain of severe pain in the leg 15 minutes after receiving the prescribed IV morphine. Pulses are faintly palpable and the foot is cool. Which action should the nurse take next?

Notify the health care provider.

A patient with a right lower leg fracture will be discharged home with an external fixation device in place. Which information will the nurse teach?

"You will need to check and clean the pin insertion sites daily."

A 22-year-old tennis player has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included?

"You will work with a physical therapist tomorrow."

A patient who slipped and fell in the shower at home has a proximal humerus fracture immobilized with a left-sided long-arm cast and a sling. Which nursing intervention will be included in the plan of care?

Assess the left axilla and change absorbent dressings as needed.

A patient arrived at the emergency department after tripping over a rug and falling at home. Which finding is most important for the nurse to communicate to the health care provider?

The right arm appears shorter than the left.

When a patient arrives in the emergency department with a facial fracture, which action will the nurse take first?

Use a cervical collar to stabilize the spine.

Which discharge instruction will the emergency department nurse include for a patient with a sprained ankle?

Use pillows to elevate the ankle above the heart.

A young man arrives in the emergency department with ankle swelling and severe pain after twisting his ankle playing basketball. Which of these prescribed collaborative interventions will the nurse implement first?

Wrap the ankle and apply an ice pack.

A patient has a long-arm plaster cast applied for immobilization of a fractured left radius. Until the cast has completely dried, the nurse should

avoid handling the cast using fingertips.

A pedestrian who was hit by a car is admitted to the emergency department with possible right lower leg fractures. The initial action by the nurse should be to

check the pedal pulses.

A patient undergoes a left above-the-knee amputation with an immediate prosthetic fitting. When the patient arrives on the orthopedic unit after surgery, the nurse should

check the surgical site for hemorrhage.

The nurse will instruct the patient with a fractured left radius that the cast will need to remain in place

for at least 3 weeks.

A 48-year-old patient with a comminuted fracture of the left femur has Buck's traction in place while waiting for surgery. To assess for pressure areas on the patient's back and sacral area and to provide skin care, the nurse should

have the patient lift the buttocks by bending and pushing with the right leg.

The day after a 60-year-old patient has an open reduction and internal fixation (ORIF) for an open, displaced tibial fracture, the priority nursing diagnosis is

risk for infection related to disruption of skin integrity.

When assessing for Tinel's sign in a patient with possible right-sided carpal tunnel syndrome, the nurse will ask the patient about

tingling in the right thumb and fingers.

Which action will the urgent care nurse take when caring for a patient who has a possible knee meniscus injury?

Apply a knee immobilizer to the affected leg.

Which action will the nurse take in order to evaluate the effectiveness of Buck's traction for a 62-year-old patient who has an intracapsular fracture of the right femur?

Ask about hip pain level.

Which nursing intervention will be included in the plan of care after a patient with a right femur fracture has a hip spica cast applied?

Ask the patient about abdominal discomfort.

Which nursing action for a patient who has had right hip replacement surgery can the nurse delegate to experienced unlicensed assistive personnel (UAP)?

Reposition the patient every 1 to 2 hours.

A 42-year-old patient is admitted to the emergency department with a left femur fracture. Which information obtained by the nurse is most important to report to the health care provider?

Slow capillary refill of the left foot

After being hospitalized for 3 days with a right femur fracture, a 32-year-old patient suddenly develops shortness of breath and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first?

Administer the prescribed PRN oxygen at 4 L/min.

When giving home care instructions to a patient who has comminuted forearm fractures and a long-arm cast on the left arm, which information should the nurse include?

Call the health care provider for increased swelling or numbness of the hand.

Which finding in a patient with a Colles' fracture of the left wrist is most important to communicate to the health care provider?

Capillary refill to the fingers is prolonged.

Following a motorcycle accident, a 58-year-old patient arrives in the emergency department with massive left lower leg swelling. Which action will the nurse take first?

Check leg pulses and sensation.

The second day after admission with a fractured pelvis, a 64-year-old patient suddenly develops confusion. Which action should the nurse take first?

Check the oxygen saturation.

A patient who has had an open reduction and internal fixation (ORIF) of a hip fracture tells the nurse that he is ready to get out of bed for the first time. Which action should the nurse take?

Check the postoperative orders for the patient's weight-bearing status.

After change-of-shift report, which patient should the nurse assess first?

Patient with right femoral shaft fracture whose thigh is swollen and ecchymotic

Which action will the nurse include in the plan of care for a patient who has had a total right knee arthroplasty?

Start progressive knee exercises to obtain 90-degree flexion.

When caring for a patient who is using Buck's traction after a hip fracture, which action can the nurse delegate to unlicensed assistive personnel (UAP)?

Ensure that the weight for the traction is off the floor.

Which information obtained by the nurse about a 29-year-old patient with a lumbar vertebral compression fracture is most important to report to the health care provider?

Patient has been incontinent of urine and stool.

When doing discharge teaching for a 19-year-old patient who has had a repair of a fractured mandible, the nurse will include information about

how and when to cut the immobilizing wires.