Med Surg. Chapter 43

Two days after application of a cast to treat a fractured femur, the patient tells the orthopedic heath care provider that he is experiencing severe, deep, and constant pain in his leg. The nurse suspects a diagnosis of:

Compartment syndrome.

Which assessment findings would cause the nurse to suspect compartment syndrome after casting of the leg?

Complaints of numbness and tingling in toes of affected leg

Which type of fracture occurs when a bone fragment is driven into another bone fragment?

Impacted

Which type of fracture involves a break through only part of the cross-section of the bone?

Incomplete

A 75-year-old patient had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which of the following complications? Select all that apply.

• Pneumonia • Skin breakdown • Sepsis • Delirium

Which of the following are associated with compartment syndrome? Select all that apply.

• Trauma from accidents • Surgery • Casts • Tight bandages • Crushing injuries

Which assessment findings would the nurse expect to find in the postoperative client experiencing fat embolism syndrome?

Column B Fat embolism syndrome is characterized by fever, tachycardia, tachypnea, and hypoxia. Arterial blood gas findings include a partial pressure of oxygen (PaO2) less than 60 mm Hg, with early respiratory alkalosis and later respiratory acidosis.

A client presents to the emergency department gently holding the left arm, which is slightly swollen and painful to the touch. Based on these findings, the nurse:

Elevates the arm and applies an ice pack

Pelvic fractures have a high mortality rate. The nurse knows to be conscientious in assessing for the two most serious complications. What are those complications?

Hemorrhage and shock

When evaluating for hypovolemic shock, the nurse should be aware of which of the following clinical manifestations?

Hypotension

A 78-year-old client is in the emergency department following involvement in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of her upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma?

Immobilization

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?

Impacted

Elderly clients who fall are most at risk for which injuries?

Pelvic fractures

Which intervention should the nurse implement, when caring for the client who complains of phantom limb pain two months after amputation?

Reassure the client that phantom pain is common.

Which nursing intervention is essential in caring for a client with compartment syndrome?

Removing all external sources of pressure, such as clothing and jewelry

Which of the following terms refers to an injury to ligaments and other soft tissues of a joint?

Sprain

A client is diagnosed with a first-degree strain of the left ankle related to running 5 miles daily. How would the nurse differentiate the first-degree strain from other strains and sprains?

The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices.

A fracture is termed pathologic when the fracture

occurs through an area of diseased bone.

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in his cast care?

"Keep your right leg elevated above heart level."

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain?

Administer prescribed analgesics around-the-clock.

A client comes to the Emergency Department complaining of localized pain and swelling of his lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely?

Contusion

Which of the following is a term used to describe a soft tissue injury produced by a blunt force?

Contusion

General nursing measures employed when caring for the client with fracture include all of the following, except?

Cranial nerve assessment

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear?

Difficulty lying on affected side

A client with a fracture develops compartment syndrome that requires surgical intervention. The nurse would most likely prepare the client for which of the following?

Fasciotomy

Which of the following is an inaccurate clinical manifestation of a fracture?

Lengthening

Nursing assessment after a closed reduction would include checking for a sign of neurovascular complications. What is the indicator?

Numbness or tingling

A client is brought to the emergency department after injuring his right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?

One side of the bone is broken and the other side is bent.

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain?

Rotator cuff tears

A 78-year-old client is in the emergency department following involvement in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of her upper extremity and admission to the orthopedic unit. Other than her bone, what other physical structures could be affected by this injury?

All options are correct.

The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding?

Clawlike deformity of the right hand without ability to extend fingers

A client who suffers an injury in a local high school hockey game presents with left shoulder pain. The client cannot move the left arm, and the left shoulder is lower than the right shoulder. The nurse recognizes the client most likely has a:

Dislocated shoulder

A 39-year-old client has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicated intact but malpositioned bones, what would you expect the physician to diagnose?

Dislocation

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing:

Fat embolism syndrome

Which of the following terms refers to a break in the continuity of a bone?

Fracture

Which of the following terms refers to a fracture in which one side of a bone is broken and the other side is bent?

Greenstick

A 39-year-old softball player has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would you expect the physician to perform?

Joint manipulation and immobilization

Which nursing assessment finding indicates the post-amputation client has not met expected outcomes?

Stump swollen and irritated

A client sustains an injury to the ligaments surrounding a joint. The nurse identifies this as which of the following?

Sprain