Med Surg: Chapter 40

Which intervention should the nurse implement with the client who has an external fixator? Select all that apply. Supervise the client during transfers. Perform pin care as ordered. Turn the clamps by one-half every day. Inspect pin sites for signs of infection. Perform neurovascular assessment.

Inspect pin sites for signs of infection. Supervise the client during transfers. Perform pin care as ordered. Perform neurovascular assessment.

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? It prevents infection and controls edema and bleeding. It provides active range of motion. It promotes healing by immobilizing the knee joint. It promotes healing by increasing circulation and movement of the knee joint.

It promotes healing by increasing circulation and movement of the knee joint.

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? Left hip arthroscopy Open reduction and internal fixation of the left hip. Closed reduction of the left hip. Left hip arthroplasty

Left hip arthroplasty

The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is: Disturbed body image Situational low self-esteem Risk for ineffective therapeutic regimen management Risk for avascular necrosis of the joint

Risk for ineffective therapeutic regimen management

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 dull, deep, boring ache Sore and aching Sharp and piercing Similar to "muscle cramps"

Sharp and piercing

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? Long leg cast Hip spica cast Walking cast Short leg cast

Short leg cast

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

Weights hanging and touching the floor

A group of students is 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? More breathable Quicker drying Longer lasting Better molding to the client

Better molding to the client.

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

Skeletal traction is interrupted to turn and reposition the client. Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely, with the client in good alignment in the center of the bed.

Which device is designed specifically to support and immobilize a body part in a desired position? Continuous passive motion (CPM) device Trapeze Brace Splint

Splint

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

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

A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse? "You would have to stay here much longer because it takes a cast longer to dry." "Not all fractures require a cast." "A splint is applied when more swelling is expected at the site of injury." "It is best if an orthopedic doctor applies the cast."

"A splint is applied when more swelling is expected at the site of injury."

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse? "CPM delivers analgesic agents directly into the joint." "CPM increases range of motion of the joint." "CPM strengthens the muscles of the leg." "CPM prevents injury by limiting flexion of the knee."

"CPM increases range of motion of the joint."

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide? "Intermittently cross and uncross your legs several times each day." "Limit hip flexion to 90 degrees." "Avoid weight bearing until the hip is completely healed." "Perform rotation exercises each day."

"Limit hip flexion to 90 degrees."

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? "I will wear a boot with weights attached." "The traction can be removed once a day so I can shower." "Metal pins will go through my skin to the bone." "A belt will go around my pelvis and weights will be attached."

"Metal pins will go through my skin to the bone."

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

"My toes are stiff"

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

"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device."

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

45 degrees onto the the unoperated side if the affected hip is kept abducted

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?

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.

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse? Reposition the client for comfort. Assess for previous opioid drug use. Teach relaxation techniques. Assess for complications.

Assess for complications. pg. 1110

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse? Teach relaxation techniques. Assess for complications. Reposition the client for comfort. Assess for previous opioid drug use.

Assess for complications. pg. 1110

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

Assessing movement and sensation in the fingers of the right hand. 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 Fiberglass 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.

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

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

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

Assisting in early ambulation.

Which cleansing solution is the most effective for use in completing pin site care? Chlorhexidine Hydrogen peroxide Betadine Alcohol

Chlorhexidine solution

Which would be contraindicated as a component of self-care activities for the client with a cast? Cushioning rough edges of the cast with tape Cover the cast with plastic to insulate it Elevate the casted extremity to heart level frequently Do not attempt to scratch the skin under a cast

Cover the cast with plastic to insulate it The cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin.

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

Crackles in the lung bases -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/minutes within normal range

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 complication? Dislocation of the hip Contracture of the hip Avascular necrosis of the hip Re-fracture of the hip

Dislocation of the hip

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

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg

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

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.

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan? Reduce fluid intake. Increase fiber intake. Remove the weights during linen changes. Increase calorie intake.

Increase fiber intake.

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

Instruct the client to avoid internal rotation of the leg.

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? Joint arthroplasty Total joint arthroplasty Open reduction Arthrodesis

Open reduction

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period? infection hematoma hemorrhage osteomyelitis

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.

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period? hemorrhage hematoma infection osteomyelitis

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.

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? Assess the client's level of consciousness. Remove the traction at least every 8 hours. Apply the traction straps snugly. Teach the client how to prevent problems caused by immobility.

Teach the client how to prevent problems caused by immobility.

Which statement describes 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. The bone is surgically exposed and realigned. The bone is restored to its normal position by external manipulation. The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied.

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

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? Arthrodesis Total arthroplasty Osteotomy Hemiarthroplasty

Total arthroplasty

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? Total arthroplasty Osteotomy Hemiarthroplasty Arthrodesis

Total arthroplasty

A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do? Remove the cast. Cut a cast window. Apply a fiberglass cast. Initiate physical therapy.

cut a cast window

Which statement is accurate regarding care of a plaster cast? A dry plaster cast is dull and gray. The cast will dry in about 12 hours. The cast must be covered with a blanket to keep it moist during the first 24 hours. 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 hip spica 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. is a short or long leg cast reinforced for strength. encloses the trunk and a lower extremity. encircles the trunk.

encloses the trunk and a lower extremity.

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 56-year-old male, who had an arthroscopy of his left knee 3 hours ago, who is asking to be discharged The order doesn't matter; all clients are of equal priority A 60-year-old female, who is in traction to manage chronic muscle spasms, who is requesting assistance to order her evening meal 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

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

A client 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?

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.

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate? Explain that the sensation being felt is normal and will not burn the client. Remove the cast immediately, notifying the physician. Administer antianxiety and pain medication. Call for assistance to hold the client in the required position until the cast has dried.

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.

The nurse is caring for a patient postoperatively following orthopedic surgery. The nurse assesses an oxygen saturation of 89%, confusion, and a rash on the upper torso. What does the nurse suspect is occurring with this patient? Fat emboli syndrome Polyethylene-induced infection Pneumonia Disseminated intravascular coagulation

Fat emboli syndrome

A nurse is caring for a client with a cast on the left arm after sustaining a fracture. Which assessment finding is most significant for this client? Minimal pain in the left arm Fingers on the left hand are swollen and cool Cast edges are rough, with skin irritation present Presence of a normal popliteal pulse

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