fractures, orthopedic devices

c)

a 22-year-old man is admitted to the emergency department with a crush injury to both lower legs. he was pinned under a car for 3 hours. on admission, his vital signs are stable; he is alert and oriented and complaining of extreme pain in his legs. popliteal pulses are strong; pedal and posterior tibial pulses are weak. the ankle and feet appear dusky; the skin is tense, but the skin envelope is not broken. x-rays show no broken bones. based upon these data, which interventions are most appropriate? a) notify the provider and anticipate that stat V/Q scan will be performed to rule out fat emboli. b) notify the provider and prepare to set up skin traction to decrease the pressure on the calf muscle. c) notify the provider and anticipate the provider will measure the pressure in the compartment and possibly perform a fasciotomy if elevated pressure is noted. d) notify the provider and prepare to give IV antibiotics stat to decrease the risk of osteomyelitis.

b)

a 23-year-old patient, experienced an open fracture of the left tibia with major soft tissue damage of his lower leg in a bicycle accident. surgical reduction and fixation of the tibia were performed with debridement of nonviable tissue and drain placement in the damaged soft tissue. which finding by the nurse would most likely indicate the development of osteomyelitis? a) tachycardia b) elevated ESR c) numbness in the left leg and toes d) muscle spasms around the affected bone

c)

a 73-year-old patient is placed in skeletal traction prior to surgery for an ORIF of fractured femur. she develops chest pain, tachypnea, and tachycardia the second day in traction. which additional symptom would indicate her symptoms are related to a fat emboli rather than a pulmonary thromboembolic event? a) hypotension b) restlessness c) petechiae of the anterior chest wall d) warm, reddened areas in her leg

d) respiratory depression due to increasing acidosis is an expected manifestation of severe aspirin toxicity.

a nurse in an urgent care center is collecting data from a client who has severe aspirin toxicity. which of the following findings should the nurse expect? a) body temperature 35 degrees C b) lung crackles c) cool, dry skin d) respiratory depression

d) amitriptyline can cause orthostatic hypotension. the nurse should monitor for this effect and instruct the client to move slowly from lying down or sitting after taking this medication.

a nurse is administering amitriptyline to a client who has cancer pain. for which of the following manifestations should the nurse monitor as an adverse effect of this medication? a) decreased appetite b) severe diarrhea c) decreased heart rate d) orthostatic hypotension

b) detection and early treatment is crucial for an epiphyseal plate injury to prevent altered bone growth.

a nurse is assisting with a group discussion about fractures. which of the following information should the nurse include? a) "children need a longer time to heal from a fracture than an adult." b) "epiphyseal plate injuries can result in altered bone growth." c) "a greenstick fracture is a complete break in the bone." d) "bones are unable to bend, so they break."

a) the nurse should administer acetylcysteine, which is the antidote for acetaminophen overdose.

a nurse is assisting with the admission of a toddler who has had an acetaminophen overdose. which of the following medications should the nurse anticipate administering to this client? a) acetylcysteine b) pegfilgrastim c) misoprostol d) naltrexone

a) dexamethasone, a glucocorticoid, decreases inflammation and swelling. it can reduce cerebral edema and relieve intracranial pressure from the tumor.

a nurse is assisting with the plan of care for a client who has brain cancer and reports headaches. which of the following adjuvant medications should the nurse expect the provider to prescribe? a) dexamethasone b) methylphenidate c) hydroxyzine d) amitriptyline

b) monitoring serum glucose is important because glucocorticoids raise the glucose level, especially in clients who have diabetes mellitus. c) monitoring serum potassium level is important because glucocorticoids can cause hypokalemia. d) monitoring for gastric bleeding is important because glucocorticoids irritate the gastric mucosa and put the client at risk for a peptic ulcer.

a nurse is assisting with the plan of care for a client who has cancer and is taking a glucocorticoid as an adjuvant medication for pain control. which of the following interventions should the nurse include? (select all that apply.) a) monitor for urinary retention. b) monitor glucose level. c) monitor potassium level. d) monitor for gastric bleeding. e) monitor for respiratory depression.

a) a fracture can leave bone fragments that will exhibit a grating sound. crepitus is a manifestation of a fracture. b) swelling at the site occurs related to the trauma. edema is a manifestation of a fracture. c) a child who has a fracture will experience pain from the trauma. e) bleeding under the skin can occur related to the trauma. ecchymosis is a manifestation of a fracture.

a nurse is caring for a child who has a fracture. which of the following are manifestations of a fracture? (select all that apply.) a) crepitus b) edema c) pain d) fever e) ecchymosis

d) the nurse should apply moleskin to the edges of the cast to prevent the cast from rubbing on the child's skin.

a nurse is caring for a child who is in a plaster shoulder spica cast. which of the following actions should the nurse take? a) use a heat lamp to facilitate drying. b) avoid turning the child until the cast is dry. c) position the cast below heart level while it dries. d) apply moleskin to the edges of the cast.

b) the nurse should check the child's position frequently to ensure proper alignment is present. this avoids putting stress on the pinned areas and other areas of the body, which can worsen the child's pain. c) the nurse should observe the pin sites frequently to monitor for the development of infection or loosening of the pins. follow facility protocol in providing pin site care. d) the nurse should ensure that the weights are hanging freely to allow for prescribed traction.

a nurse is caring for a child who is in skeletal traction. which of the following actions should the nurse take? (select all that apply.) a) remove the weights to reposition the child. b) check the child's position frequently. c) observe pin sites every 4 hr. d) ensure the weights are hanging freely. e) ensure the rope's knot is in contact with the pulley.

b) elevating the affected limb can decrease swelling at the injury site. c) checking neurovascular status assists the nurse in determining if the affected limb had adequate blood supply. e) stabilizing the injury will prevent further injury and damage.

a nurse is caring for a child who sustained a fracture. which of the following actions should the nurse take? (select all that apply.) a) place a heat pack on the site of injury. b) elevate the affected limb. c) check neurovascular status frequently. d) encourage ROM of the affected limb. e) stabilize the injury.

c) methylnaltrexone is an opioid antagonist that treats severe constipation that has not responded to laxatives in clients who have opioid dependency. the medication blocks the mu opioid receptors in the GI tract.

a nurse is caring for a client who had end-stage cancer and is receiving morphine. the client's daughter asks why the provider prescribed methylnaltrexone. which of the following responses should the nurse make? a) "the medication will increase your mother's respiratory rate." b) "the medication will prevent dependence on morphine." c) "the medication will relieve your mother's constipation." d) "the medication works with morphine to increase pain relief."

b) buck's traction is a temporary immobilization device applied to a client who has a femur or hip fracture to diminish muscle spasms and immobilize the affected extremity until surgery is performed.

a nurse is caring for a client who has a right hip fracture. which of the following immobilization devices should the nurse anticipate? a) skeletal traction b) buck's traction c) halo traction d) bryant's traction

a) the provider can reduce the dosage of the opioid when adding adjuvant medications for pain. b) adjuvant medications can reduce the adverse effects of the opioid. c) adjuvant medications increase the analgesic effects of the opioid.

a nurse is caring for a client who has cancer and is taking morphine and carbamazepine for pain relief. which of the following effects should the nurse monitor for? (select all that apply.) a) the need for a lower dosage of the opioid b) reduced adverse effects of the opioid c) increased analgesic effects d) enhanced CNS stimulation e) increased opioid tolerance

d) the nurse should remind the client to cough at regular intervals to prevent the accumulation of secretions in the airway, because opioid medications can cause cough suppression.

a nurse is caring for a client who is receiving morphine postoperatively. which of the following actions should the nurse take? a) have alvimopan available to reverse excessive sedation. b) protect the client's skin from severe diarrhea that morphine causes. c) withhold this medication for respiratory rate less than 16/min. d) encourage the client to cough at regular intervals.

a) seizure activity is an adverse effect that can occur as a result of local anesthetic injection.

a nurse is caring for a client who receives an injection of lidocaine during the repair of a skin laceration. the nurse should monitor for which of the following adverse reactions? a) seizures b) tachycardia c) hypertension d) fever

a) intense pain of the left foot when passively moved can indicate pressure from edema on nerve endings and is a manifestation of compartment syndrome. c) a hard, swollen muscle on the affected extremity indicates edema build-up in the are of injury and is a manifestation of compartment syndrome. d) burning and tingling of the left foot indicates pressure from edema on nerve endings and is an early manifestation of compartment syndrome. e) minimal pain relief after receiving opioid medication can indicate pressure from edema on nerve endings and is an early manifestation of compartment syndrome.

a nurse is collecting data from a client who had an external fixation device applied 2 hr ago for a fracture of the left tibia and fibula. the nurse should identify which of the following findings as manifestations of compartment syndrome? (select all that apply.) a) intense pain when the left foot is passively moved b) capillary refill of 3 sec on the left toes c) hard, swollen muscle in the left leg d) burning and tingling of the left foot e) client report of minimal pain relief following a second dose of opioid medication

a) altered mental status is an early manifestation of fat emboli. other manifestations include dyspnea, chest pain, and hypoxemia.

a nurse is collecting data from a client who has a casted compound fracture of the femur. the nurse should identify which of the following findings as a manifestation of fat emboli? a) altered mental status b) reduced bowel sounds c) swelling of the toes distal to the injury d) pain with passive movement of the foot distal to the injury

a) manifestations of salicylism include dizziness, drowsiness, and confusion. b) manifestations of salicylism include diarrhea, nausea, and vomiting. d) manifestations of salicylism include tinnitus, sweating, and flushing. e) manifestations of salicylism include headache, tachycardia, and tachypnea.

a nurse is collecting data from a client who has salicylism. which of the following findings should the nurse expect? (select all that apply.) a) dizziness b) diarrhea c) jaundice d) tinnitus e) headache

c) aspirin, which inhibits platelet aggregation, increases the effects of warfarin and other anticoagulants. this client would have an increased risk for bleeding.

a nurse is collecting data from a client who reports taking aspirin about for times daily to relieve the pain of a wrist sprain. which of the following medications interacts adversely with aspirin? a) digoxin b) levothyroxine c) warfarin d) nitroglycerin

a) the nurse should keep the client NPO following the procedure until normal pharyngeal sensation returns and should then monitor the client's first oral intake to make sure aspiration does not occur.

a nurse is contributing to the plan of care for a client who is to receive tetracaine prior to a bronchoscopy. which of the following actions should the nurse suggest for the plan of care? a) keep the client NPO until pharyngeal sensation returns. b) monitor the insertion site for a hematoma. c) palpate the bladder to detect urinary retention. d) keep the client in bed for 12 hr after the procedure.

a) the nurse should monitor for urinary retention by palpating the client's abdomen regularly because morphine can suppress awareness that the bladder is full.

a nurse is preparing to administer an opioid agonist to a client who has acute pain. the nurse should monitor for which of the following complications? a) urinary retention b) tachypnea c) tinnitus d) joint pain

d) opioid agonist/antagonist medications, such as butorphanol, can cause abstinence syndrome in clients who have opioid dependency. manifestations include hypertension, vomiting, fever, and anxiety.

a nurse is preparing to administer butorphanol to a client who has a history of substance use disorder. the nurse should be aware of which of the following information about butorphanol? a) butorphanol has a greater risk for misuse than morphine. b) butorphanol causes a higher incidence of respiratory depression than morphine. c) opioid antagonists cannot reverse the effects of butorphanol. d) butorphanol can cause abstinence syndrome in clients who have opioid dependency.

a) treatment of osteomyelitis includes continuing antibiotic therapy for 3 months.

a nurse is reinforcing discharge teaching with a client who had a wound debridement for osteomyelitis. which of the following information should the nurse include? a) antibiotic therapy should continue for 3 months. b) relief of pain indicates the infection is eradicated. c) airborne precautions are used during wound care. d) expect paresthesia distal to the wound.

a) celecoxib increases the risks for a myocardial infarction because is suppresses vasodilation.

a nurse is reinforcing teaching with a client about celecoxib. which of the following information should the nurse include? a) increases the risk of a myocardial infarction b) decreases the risk of stroke c) inhibits COX-1 d) increases platelet aggregation

a) clean the external fixation pins one or two times each day to remove exudate that can harbor bacteria. b) using a separate cotton swab on each pin will decrease the risk of cross-contamination, which could cause pin site infection. c) notify the provider if a pin is loose so the provider can tighten the pin to prevent damage to the tissue and bone. e) the client should report redness, heat, and drainage at the pin sites, which can indicate an infection that can lead to osteomyelitis.

a nurse is reinforcing teaching with a client about how to manage an external fixation device upon discharge. which of the following client statements indicate understanding? (select all that apply.) a) " i will clean the pins twice a day." b) "i will use a separate cotton swab for each pin." c) "i will report loosening of the pins to my doctor." d) "i will clean the pins with tap water and antibacterial soap." e) "i will report increased redness at the pin sites."

c) the nurse should instruct the client to sit or stand upright for 30 to 60 min after taking it to minimize the risk of esophagitis.

a nurse is reinforcing teaching with a client who has a new prescription for etidronate to help relieve bone pain. which of the following instructions should the nurse include? a) wait 30 min after taking the medication before eating any food. b) take the medication with 30 mL water. c) sit upright or stand for 30 min after taking the medication. d) increase fluid and fiber intake to prevent the constipation the medication causes.

c) a client who has a positive home pregnancy test should stop taking ergotamine and notify the provider. ergotamine is in pregnancy risk category X and can cause abortion. d) numbness and tingling in fingers or toes is a finding with ergotamine overdose. the client should stop taking the medication and notify the provider. e) unexplained muscle pain is a finding with ergotamine overdose. the client should stop taking the medication and notify the provider.

a nurse is reinforcing teaching with a client who has migraine headaches and a new prescription for ergotamine. the client should stop taking the medication and notify the provider for which of the following adverse effects? (select all that apply.) a) nausea b) visual disturbances c) positive home pregnancy test d) numbness and tingling in fingers e) muscle pain

b) identifying and avoiding trigger factors is an important action that can help prevent some migraine headaches. c) lying down in a dark, quiet room at the onset of a migraine headache can prevent the onset of more severe manifestations. d) foods that contain tyramine can be a trigger for some migraine headaches. the client should avoid foods that contain tyramine.

a nurse is reinforcing teaching with a client who has migraine headaches. which of the following instructions should the nurse provide? (select all that apply.) a) take ergotamine to prevent migraine headaches. b) identify and avoid factors that trigger migraine headaches. c) lie down in a dark quiet room at the onset of a migraine headache. d) avoid foods that contain tyramine. e) avoid exercise that can increase heart rate.

d) first-degree heart block is a contraindication for taking propranolol. the nurse should report this finding to the provider.

a nurse is reviewing the health history of a client who has migraine headaches and is to begin prophylaxis with propranolol. which of the following findings should the nurse report to the provider? a) the client had a prior MI. b) the client takes warfarin for atrial fibrillation. c) the client takes an SSRI for depression. d) and ECG indicates a first-degree heart block.

b) diazepam, a benzodiazepine, is a CNS depressant, which can interact by causing excessive sedation when the client receives it concurrently with an opioid agonist or agonist/antagonist.

a nurse is reviewing the medication administration record of a client who is receiving transdermal fentanyl for the relief of severe pain. which of the following medications should the nurse expect to cause an adverse effect if the client receives is concurrently with fentanyl? a) ampicillin b) diazepam c) furosemide d) prednisone

b)

during assessment of a patient admitted to the emergency room after a motor vehicle collision, he becomes semi-conscious and continues moaning with pain. his blood pressure has now decreased to 100/42, and his pulse has increased to 122. what is the most common immediate life-threatening problem for this patient? a) arrhythmias due to hypokalemia b) hypovolemia c) respiratory depression from pain medication d) fat embolus to the lung

b)

in the immediate postoperative period, which measure would best prevent a DVT? a) adding a multivitamin to the patient's medication b) early ambulation c) measuring intake and output d) lowering the legs below the level of the heart