MS2- Exam 3- Possible Questions

Which action should the nurse take to evaluate the effectiveness of Buck's traction for a patient who has an intracapsular fracture of the right femur? A. Assess for hip pain. B. Check for contractures. C. Palpate peripheral pulses. D. Monitor for hip dislocation.

ANS: A Rationale: Buck's traction is used to reduce painful muscle spasm. Hip contractures and dislocation are unlikely to occur in this situation. The peripheral pulses will be assessed, but this does not help in evaluating the effectiveness of Buck's traction.

A patient with a right lower leg fracture will be discharged home with an external fixation device in place. Which statement should the nurse including in discharge teaching? A. "Check and clean the pin insertion sites daily." B. "Remove the external fixator for your shower." C. "Remain on bed rest until bone healing is complete." D. "Take prophylactic antibiotics until the fixator is removed."

ANS: A Rationale: Pin insertion sites should be cleaned daily to decrease risk for infection at the site. An external fixator allows the patient to be out of bed and avoid the risks of prolonged immobility. The device is surgically placed and is not removed until the bone is stable. Prophylactic antibiotics are not routinely given during external fixator use.

Which statement by an adolescent patient recovering from a sprain would indicate the need for further instruction by the nurse regarding care at home? A. "I should put a heating pad on my leg as soon as I get home." B. "I should avoid weight bearing on this leg for a couple days." C. "I should make sure to keep the Ace bandage on my leg." D. "I should prop this leg up when I'm sitting in a chair."

ANS: A Rationale: RICE (rest, ice, compression, elevation) is a recommended therapy for treating soft tissue trauma. These interventions allow the injured muscle, ligament, or tendon to heal (rest), cause vasoconstriction and reduce pain (ice), reduce edema formation (compression), and reduce edema and pain (elevation). Planning to use a heating pad would indicate the need for additional instruction by the nurse. Incorrect: Interventions should allow the injured muscle, ligament, or tendon to heal (rest). This therapy should be used for 24 to 48 hours. Interventions to reduce edema formation will be necessary for 24 to 48 hours. Interventions to reduce edema and pain should be used for 24 to 48 hours.

For a patient who has had right hip arthroplasty, which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP)? A. Reposition the patient every 1 to 2 hours. B. Assess for skin irritation on the patient's back. C. Teach the patient quadriceps-setting exercises. D. Determine the patient's pain intensity and tolerance.

ANS: A Rationale: Repositioning of orthopedic patients is within the scope of practice of UAP after they have been trained and evaluated in this skill. The other actions should be done by licensed nursing staff members.

A 65-year-old female admitted with a fractured hip tells the nurse that she was unaware that she has osteoporosis. What is the nurse's best response? A. "Sometimes the first sign of the disorder is a fracture." B. "It is rare for someone your age to have osteoporosis." C. "There is no way to prevent the disorder." D. "Everyone has it now."

ANS: A Rationale: The manifestations of osteoporosis may go undetected because many patients are asymptomatic. The first sign of the disorder may be a fracture. There are different types of osteoporosis that occur in postmenopausal women as a natural result of aging. It is not rare for a 65-year-old female to be diagnosed with the disorder. Osteoporosis can be prevented by sufficient intake of calcium and vitamin D, weight management, and exercise. Not everyone has osteoporosis.

A patient who has had open reduction and internal fixation (ORIF) of a hip fracture tells the nurse he is ready to get out of bed for the first time. Which action should the nurse take? A. Check the patient's prescribed weight-bearing status. B. Use a mechanical lift to transfer the patient to the chair. C. Decrease the pain medication before getting the patient up. D. Have the unlicensed assistive personnel (UAP) transfer the patient.

ANS: A Rationale: The nurse should be familiar with the weight-bearing orders for the patient before attempting the transfer. Mechanical lifts are not typically needed after this surgery. Pain medications should be given because the movement is likely to be painful for the patient. The registered nurse (RN) should supervise the patient during the initial transfer to evaluate how well the patient is able to accomplish the transfer.

A patient undergoes left above-the-knee amputation with an immediate prosthetic fitting. What should the nurse do when the patient arrives on the orthopedic unit after surgery? A. Assess the surgical site for hemorrhage. B. Remove the prosthesis and wrap the site. C. Place the patient in a side-lying position. D. Keep the residual limb elevated on a pillow.

ANS: A Rationale: The nurse should monitor for postoperative hemorrhage. The prosthesis will not be removed. To avoid flexion contracture of the hip, the leg will not be elevated on a pillow. Unless contraindicated, the patient will be placed in a prone position for 30 minutes several times a day to prevent hip flexion contracture.

A patient who had open reduction and internal fixation (ORIF) of left lower leg fractures continues to report severe pain in the leg 15 minutes after receiving the prescribed IV morphine. The nurse determines pulses are faintly palpable and the foot is cool to the touch. Which action should the nurse take next? A. Notify the health care provider. B. Assess the incision for redness. C. Reposition the left leg on pillows. D. Check the patient's blood pressure.

ANS: A Rationale: The patient's clinical manifestations suggest compartment syndrome and delay in diagnosis and treatment may lead to severe functional impairment. The data do not suggest problems with blood pressure or infection. Elevation of the leg will decrease arterial flow and further reduce perfusion.

A patient has a dislocated hip as the result of a fall. The nurse recognizes which primary reason to quickly return the femoral head to its normal position? A. To preserve blood flow to the head of the femur B. To avoid damage to nerves in the affected area C. To minimize the damage to affected ligaments D. To eliminate the severe pain the patient is experiencing

ANS: A Rationale: A dislocation is a displacement of a bone from its normal position in a joint. While the dislocation requires reduction as soon as possible to reduce damage, the primary concern is interference with blood supply to the femoral head. This can lead to severe complications such as avascular necrosis (AVN). Incorrect: Damage to nerves in the affected area is a potential complication of dislocation. This is a serious situation but is not the highest priority. Damage to ligaments is a potential complication of dislocation. This is a serious situation but is not the highest priority. Pain occurs with dislocation. This is a serious situation but is not the highest priority.

Following hip replacement surgery, which patient statement would the nurse evaluate as indicating additional teaching is necessary? A. "I will sit down in a chair to reach items below waist height." B. "I will use a shower chair and raised toilet seat when performing hygiene." C. "My husband has removed our loose carpets and has cleared out our walkway." D. "My daughter bought me a 'reacher' to access things on the floor."

ANS: A Rationale: Sitting in a chair and trying to reach below waist level places the hip at a flexion angle of more than 90 degrees. Dislocation is possible. Incorrect: A shower chair and raised toilet seat keep the hips at the correct angle to prevent displacement. Loose carpets and objects in walkways may cause falls and further injure the patient and/or the hip replacement itself. Using a reacher will prevent bending or stooping that might cause hip displacement.

What should the occupational health nurse advise a patient whose job involves many hours of typing? A. Obtain a keyboard pad to support the wrist. B. Do stretching exercises before starting work. C. Wrap the wrists with compression bandages every morning. D. Avoid using non-steroidal anti-inflammatory drugs (NSAIDS).

ANS: A Repetitive strain injuries caused by prolonged work at a keyboard can be prevented by using a pad to keep the wrists in a straight position. Stretching exercises during the day may be helpful, but these would not be needed before starting work. Use of a compression bandage is not needed, although a splint may be used for carpal tunnel syndrome. NSAIDs are appropriate to decrease swelling.

The nurse is caring for a patient whose fractured left femur was surgically managed with intramedullary (I-M) rodding. The nurse would explain which benefits of this type of fixation? Select all that apply. A. It results in only minimal skin scarring. B. It does not interfere with range of motion. C. It facilitates direct visualization of the fracture. D. It reduces the risk of a postsurgical fat embolus. E. It allows for early weight bearing.

ANS: A, B, E Rationale: The benefits of this fixation method include small surgical scars in less obvious places than with other methods. This fixation method leaves the joint free to move so there is less interference with range of motion. Intramedullary (I-M) rodding is a method of fracture fixation that entails sliding a metal rod down the medullary canal of a long bone. This form of fixation allows for early weight bearing because it shares the load. Incorrect: If direct visualization of the fracture is required, the open reduction method of the repair is chosen. There is a slightly higher risk of fat embolism with this method.

The nurse is caring for a patient who has a grade II open fracture of the humerus. The nurse plans care for this patient based on which understanding? Select all that apply. A. Some crushing of the bone has occurred. B. Major vascular reconstruction will be required. C. There is a moderately high risk for developing an infection. D. The patient has an "inside-out" fracture. E. An inspection and debridement (I&D) procedure will be required.

ANS: A, C, E Rationale: A grade II open fracture has a moderately contaminated wound bed and contains a moderate amount of comminution (bone fragments). All open fractures have the potential to be contaminated, thus increasing the risk of infection. The wound requires a procedure to wash out the contamination; this is commonly referred to as an inspection and debridement (I&D). Incorrect: If major vascular reconstruction is required, grade III is assigned. A grade I open fracture is sometimes referred to as an "inside-out" fracture.

The nurse should assess a patient with a long leg cast for which signs that would indicate compromised circulation? Select all that apply. A. Swelling of the toes B. Drainage on the cast C. Elevated temperature D. Foul odor E. A tight cast

ANS: A, E Swelling of the toes is likely due to decreased venous return caused by the cast being too tight. Edema can cause the cause to become tight. A tight-fitting cast can lead to compartment syndrome. Incorrect: Drainage may indicate bleeding or infection. An elevated temperature indicates infection. Foul odor indicates an infective process.

A tennis plater has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. Which information will the nurse include in postoperative teaching? A. "You will not be able to serve a tennis ball again." B. "You will begin work with a physical therapist tomorrow." C. "Keep the shoulder immobilizer on for the first 4 days to minimize pain." D. "The surgeon will use the drop arm test to determine the success of surgery."

ANS: B Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent "frozen shoulder." A shoulder immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of range of motion. The drop arm test is used to test for rotatory cuff injury but not after surgery. The patient may be able to return to tennis after rehabilitation.

Which action should the urgent care nurse take for a patient with a possible knee meniscus injury? A. Encourage bed rest for 24 to 48 hours. B. Apply an immobilizer to the affected leg. C. Avoid palpation or movement of the knee. D. Administer intravenous opioids for pain management.

ANS: B Rationale: A knee immobilizer may be used for several days after a meniscus injury to stabilize the knee and minimize pain. Patients are encouraged to ambulate with crutches. The knee is assessed by flexing, internally rotating, and extending the knee (McMurray's test). The pain associated with a meniscus injury will not typically require IV opioid administration. Nonsteroidal antiinflammatory drugs (NSAIDs) are recommended for pain management.

A 60-yr-old patient had open reduction and internal fixation (ORIF) for an open, displaced tibial fracture, What should the nurse identify as the priority patient problem? A. Acute pain B. Risk for infection C. Activity intolerance D. Risk for constipation

ANS: B Rationale: A patient having ORIF is at risk for problems such as wound infection and osteomyelitis. After ORIF, patients typically are mobilized starting the first postoperative day, so the problems caused by immobility are not as likely. Pain management is important, but the most important action is to prevent infection.

A patient has had hip replacement surgery. What is the nurse's best plan to address this patient's ambulation needs? A. Keep both bed rails up at all times so the patient will not attempt ambulation without assistance. B. Teach the patient how to use a walker. C. Have the patient practice log-rolling to the side of the bed before getting up. D. Have the patient use a wheelchair until the hip is completely healed.

ANS: B Rationale: A walker provides stable support to prevent falling injuries. The ability to bear weight on the surgical leg varies, based on the type of surgery performed, but a walker gives a more stable base than a cane or crutch assistive device. Incorrect: Keeping both bed rails up can be construed as enforcing a restrictive environment and is not the best option. The patient should not log-roll as this may cause hip dislocation. The patient will start walking very early in recovery. A wheelchair is needed only if the patient must travel long distances.

A patient recovering from a total hip replacement develops a fever and redness at the surgical site. The nurse's priority is to conduct additional assessment for which disorder? A. Pathologic fracture B. Osteomyelitis C. Undiagnosed osteitis deformans D. Subacute osteoporosis

ANS: B Rationale: Acute osteomyelitis results from direct trauma or surgery. It is the direct contact of bacteria or the implanting of bacteria from the outside environment during a surgical procedure. Symptoms of acute osteomyelitis include fever, edema at the surgical site, warmth, redness, tenderness, and limited mobility. Pathologic fracture occurs in the absence of trauma. Fever and redness are not manifestations of pathologic fracture. Osteitis deformans is a chronic disorder that causes irregular bone breakdown and bone weakness. Subacute osteoporosis is not a clinical disorder.

The day after a having a right below-the-knee amputation, a patient reports pain in the missing right foot. Which action is most important for the nurse to take? A. Explain the reasons for the pain. B. Administer prescribed analgesics. C. Reposition the patient to assure good alignment. D. Tell the patient that the pain will diminish over time.

ANS: B Rationale: Acute phantom limb sensation is treated as any other type of postoperative pain would be treated. Explanations of the reason for the pain may be given, but the nurse should still medicate the patient. Alignment is important but is unlikely to relieve the pain. Although the pain may decrease over time, it currently requires treatment.

Which nursing intervention would be included in pain management of a patient after orthopedic surgery? A. Administering pain medications only when the patient is awake B. Anticipatory pain management prior to therapy C. Assessing vital signs to evaluate the degree of pain D. Encourage the patient to lengthen the time intervals between pain medication doses.

ANS: B Rationale: Anticipatory pain management will improve the efforts during therapy to speed up the recovery process. Better pain management that is more consistently given will improve outcomes of recovery and patient satisfaction. Incorrect: Pain medications should be given around the clock for more effective management of pain at all times. Vital signs do not always reflect the degree of pain experienced by the patient. The nurse should treat the pain to prevent pain-related complications. Encouraging the patient to lengthen the time between doses of pain medication is not good practice.

The nurse should instruct a patient with a nondisplaced fractured left radius that the cast will need to remain in place for what amount of time? A. Two weeks B. At least six weeks C. Until swelling of the wrist has resolved D. Until x-rays show complete bony union

ANS: B Rationale: Bone healing starts immediately after the injury, but because ossification does not begin until 3 weeks after injury, the cast will need to be worn for at least 3 weeks. Complete union may take up to 1 year. Resolution of swelling does not indicate bone healing.

After change-of-shift report, which patient should the nurse assess first? A. Patient with a repaired mandibular fracture who is reporting facial pain. B. Patient with repaired right femoral shaft fracture who reports tightness in the calf. C. Patient with an unrepaired Colles' fracture who has right wrist swelling and deformity. D. Patient with an unrepaired intracapsular left hip fracture whose leg is externally rotated.

ANS: B Rationale: Calf swelling after a femoral shaft fracture suggests possible DVT or compartment syndrome. The nurse should assess the patient rapidly and then notify the health care provider. The other patients have symptoms that are typical for their injuries but do not require immediate intervention.

Which information about a patient with a lumbar vertebral compression fracture should the nurse immediately report to the health care provider? A. Patient declines to be turned due to back pain. B. Patient has been incontinent of urine and stool. C. Patient reports lumbar area tenderness to palpation. D. Patient frequently uses oral corticosteroids to treat asthma.

ANS: B Rationale: Changes in bowel or bladder function indicate possible spinal cord compression and should be reported immediately because surgical intervention may be needed. The other findings are also pertinent but are consistent with the patient's diagnosis and do not require immediate intervention.

The nurse is planning care for a patient who had an above-the-knee amputation 2 days ago. Which position should the nurse include in this patient's plan of care? A. Sims' position as tolerated B. Flat in bed C. High Fowler's position with the stump elevated D. Sitting in a chair while awake

ANS: B Rationale: Lying flat in bed keeps the hip extended, which helps to prevent contracture. Incorrect: Sims' position is side-lying and would likely be uncomfortable for the patient. After 24 hours, the stump should not be elevated. Sitting in a chair for prolonged periods can lead to hip contracture.

A patient who is to have no weight bearing on the left leg is learning to use crutches. Which observation by the nurse indicates the patient can safely ambulate independently? A. The patient moves the right crutch with the right leg and then the left crutch with the left leg. B. The patient advances the left leg and both crutches together and then advances the right leg. C. The patient uses the bedside chair to assist in balance as needed when ambulating in the room. D. The patient keeps the padded area of the crutch firmly in the axillary area when ambulating.

ANS: B Rationale: Patients are usually taught to move the crutches and the injured leg forward at the same time and then to move the unaffected leg. If the 2- or 4-point gait is to be used, the crutch and leg on opposite sides move forward, not the crutch and same-side leg.Patients are discouraged from using furniture to assist with ambulation. The patient is taught to place weight on the hands, not in the axilla, to avoid brachial plexus damage.

A patient who arrives at the emergency department with severe left knee pain is diagnosed with a patellar dislocation. What should be the nurse's initial focus for patient teaching? A. Use of a knee immobilizer B. Monitored anesthesia care C. Physical activity restrictions D. Performance of gentle knee flexion

ANS: B Rationale: The first goal of interprofessional management is realignment of the knee to its original anatomic position, which will require anesthesia or monitored anesthesia care, formerly called conscious sedation. Immobilization, gentle range-of-motion exercises, and discussion about activity restrictions will be implemented after the patella is realigned.

Which information should the nurse include in discharge teaching for a patient who has had a repair of a fractured mandible? A. Administration of nasogastric tube feedings B. How and when to cut the immobilizing wires C. The importance of high-fiber foods in the diet D. The use of sterile technique for dressing changes

ANS: B Rationale: The jaw will be wired for stabilization, and the patient should know what emergency situations require the wires to be cut to protect the airway. There are no dressing changes for this procedure. The diet is liquid, and patients are not able to chew high-fiber foods. Initially, the patient may receive nasogastric tube feedings, but by discharge, the patient will swallow liquid through a straw.

Which statement by a patient who has had an above-the-knee amputation indicates the nurse's discharge teaching has been effective? A. "I should elevate my residual limb on a pillow 2 or 3 times a day." B. "I should lie flat on my abdomen for 30 minutes 3 or 4 times a day." C. "I should change the limb sock when it becomes soiled or each week." D. "I should use lotion on the stump to prevent skin drying and cracking."

ANS: B Rationale: The patient lies in the prone position several times daily to prevent flexion contractures of the hip. The limb sock should be changed daily. Lotion should not be used on the stump. The residual limb should not be elevated because this would encourage hip flexion contracture.

Before assisting a patient with ambulation 2 days after total hip arthroplasty, which action is most important for the nurse to take? A. Observe output from the surgical drain. B. Administer prescribed pain medication. C. Instruct the patient about benefits of early ambulation. D. Change the dressing and document the wound appearance.

ANS: B Rationale: The patient should be adequately medicated for pain before any attempt to ambulate. Instructions about the benefits of ambulation may increase the patient's willingness to ambulate but decreasing pain with ambulation is more important. The presence of an incisional drain or timing of dressing change will not affect ambulation.

After being hospitalized for 3 days with a right femur fracture, a 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? A. Stay with the patient and offer reassurance. B. Administer prescribed PRN O2 at 4 L/min. C. Check the patient's legs for swelling or tenderness. D. Notify the health care provider about the symptoms.

ANS: B Rationale: The patient's clinical manifestations and history are consistent with a pulmonary embolism, and the nurse's first action should be to ensure adequate oxygenation. The nurse should offer reassurance to the patient but meeting the physiologic need for O2 is a higher priority. The health care provider should be notified after the O2 is started and pulse oximetry obtained concerning suspected fat embolism or venous thromboembolism.

The nurse would recognize the need for additional teaching in a patient after posterior hip replacement when observing which activity? A. The patient uses an abductor pillow while in bed. B. The patient uses a regular-height toilet seat. C. The patient keeps the affected leg and foot turned upright while in bed. D. The patient keeps the operative leg straight when getting out of bed and uses the arms to push up out of bed.

ANS: B Rationale: The toilet seat height needs to be raised to prevent overextension of the hip joint. Additional teaching is needed to prevent complications from the posterior hip replacement. Incorrect: An abductor pillow is required to keep the hip in proper alignment and prevent it from popping out of place. An upright position keeps the leg and hip in proper alignment to prevent displacement; the leg is not turned inward for the same reason. Keeping the leg straight and using the arms prevent displacement from twisting the hip when getting out of bed.

The nurse is caring for a patient who is using Buck's traction after a hip fracture. Which action can the nurse delegate to experienced unlicensed assistive personnel (UAP)? A. Remove and reapply traction periodically. B. Ensure the weight for the traction is hanging freely. C. Monitor the skin under the traction boot for redness. D. Check for intact sensation and movement in the affected leg.

ANS: B Rationale: UAP can be responsible for maintaining the integrity of the traction after it has been established. The RN should assess the extremity and assure manual traction is maintained if the traction device has to be removed and reapplied. Assessment of skin integrity and circulation should be done by the registered nurse (RN).

The patient is diagnosed with an oblique fracture of the left femur. The nurse understands that the process of bone healing occurs in phases. Place in order the phases of the bone healing process. A. Reparative phase B. Initial injury (fracture) C. Inflammatory phase D. Remodeling phase

ANS: B, C, A, D Rationale: The bone healing process begins after the initial injury or fracture. The bleeding and inflammation that develop at the site of the fracture initiate the inflammatory phase. Calcium is deposited during the inflammatory phase and a callus forms in the reparative phase. Collagen forms and calcium deposition continues. During the remodeling phase, excess callus is removed and new bone is laid down along the fracture line. The fracture site calcifies and the bone reunites.

A patient is admitted after traumatic amputation of the left leg just below the knee. This crushing injury occurred at work while the patient was taking a smoking break. The nurse provides care based on which knowledge? Select all that apply. A. Crushing injuries are usually suitable for reattachment of the limb. B. The patient's report of pain in the area of the amputated foot is real. C. Smoking is a significant risk factor for impaired healing of reattached limbs. D. The recovery period for a limb reattachment would be similar to that for a surgical amputation. E. Nerve regeneration to a reattached lower limb usually results in poor function.

ANS: B, C, E Rationale: The patient may have bizarre sensations, such as feeling as if the absent foot is cold or itchy. These are called phantom limb sensations. Reattachment may not be attempted in patients who smoke because of the risk of impaired healing. Surgical reattachment of a severed limb is done only under certain circumstances because the surgery is difficult. For adults, it is nearly impossible for nerves to regenerate in the lower extremity, and the reattached limb may be painful and dysfunctional. Incorrect: Reattachment in crush-type amputations is not attempted due to the poor outcome. Complete amputation and prosthesis could allow a patient to return to normal activities in days to weeks, whereas reconstruction of mangled limbs can span years, with a huge psychological strain and impact on function and occupation.

The nurse explains to a patient who is having a cast removed that the remodeling phase of fracture healing involves which changes? Select all that apply. A. Creation of the cartilage collar at the fracture site B. Application of stress and weight to the affected bone C. Granulation of new bone tissue to form the connective bridge D. Resorption of excess new bone at the site of the callus E. Strengthening of the new bone at the site of the fracture

ANS: B, D, E Rationale: The remodeling process is directed by mechanical stress and weight bearing, causing the bone to become stronger in relation to its function. The remodeling process involves resportion of the excess callus in the marrow space and the external aspect of the fracture. The process is directed by mechanical stress and weight bearing, causing the bone to become stronger in relation to its function. Incorrect: A cartilage collar does form, but not in the remodeling phase. Granulation is involved in the formation of a connective bridge, but this does not occur in the remodeling phase.

The nurse would immediately report to the surgeon which finding in a patient who had a total knee replacement within the last 24 hours? A. Diminished sensations in both legs and feet B. Motor strength of 4 in the unaffected leg C. Capillary refill time of 5 seconds in the toes of the surgical leg D. Slight pallor and skin coolness bilaterally

ANS: C Rationale: A capillary refill time of less than 3 seconds is considered normal. It is prolonged in this patient, which might indicate compromised arterial flow in the surgical leg, and notification is necessary. Incorrect: Diminished sensation in both legs is a reflection of prolonged neurovascular changes and should be compared to the presurgical status; it is probably not related to the surgery itself and immediate notification is not required. Motor strength of 4 in the unaffected leg does not require immediate notification of the healthcare provider; is is probably not related to the surgery. Pallor and cool skin temperature can reflect arterial flow decreases, but in this patient it is bilateral. This finding needs further investigation, but it is not urgent and probably not related to the surgery itself.

A patient arrived at the emergency department after tripping over a rug and falling at home. Which finding should the nurse identify as most important to communicate to the health care provider? A. There is bruising at the shoulder area. B. The patient reports arm and shoulder pain. C. The right arm appears shorter than the left. D. There is decreased shoulder range of motion.

ANS: C Rationale: A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency. Bruising, pain, and decreased range of motion should also be reported, but these do not indicate emergent treatment is needed to preserve function.

What should the nurse include when teaching older adults at a community reaction center about ways to prevent fractures? A. Tack down scatter rugs on the floor in the home. B. Expect most falls to happen outside the home in the yard. C. Buy shoes that provide good support and are comfortable to wear. D. Get instruction in range-of-motion exercises from a physical therapist.

ANS: C Rationale: Comfortable shoes with good support will help decrease the risk for falls. Scatter rugs should be eliminated, not just tacked down. Activities of daily living provide range-of-motion exercise; these do not need to be taught by a physical therapist. Falls inside the home are responsible for many injuries.

Which findings would indicate possible compromise of ulnar nerve integrity following surgical repair of a patient's elbow? A. Edema in the forearm that is rated 3+ B. Pain radiating from the wrist to the middle finger C. Inability to make the "OK" sign by bringing the thumb to the fourth or fifth finger D. Slight flexion limitation (less than 15 degrees) during passive ROM

ANS: C Rationale: Compression from bleeding or severe swelling at the ulnar nerve would not allow the finger and thumb to be brought together without severe pain. Incorrect: Edema in the forearm rated at 3+ is a symptom of impaired circulation above the site of the edema, either from a tight dressing or cast; it is not a symptom of compromised ulnar integrity. Numbness in the ring and pinkie fingers is a symptom of compartment syndrome that will occur with compromise of the ulnar nerve. Radiating pain from the wrist to the middle finger would not be an expected finding. Slight flexion limitations are a symptom of musculoskeletal shortening that comes with disuse and are not a symptom related to ulnar integrity changes.

Which discharge instruction should the emergency department nurse include for a patient with a sprained ankle? A. Keep the ankle loosely wrapped with gauze. B. Apply a heating pad to reduce muscle spasms. C. Use pillows to elevate the ankle above the heart. D. Gently move the ankle through the range of motion.

ANS: C Rationale: Elevation of the leg will reduce swelling and pain. Compression bandages are used to decrease swelling. For the first 24 to 48 hours, cold packs are used to reduce swelling. The ankle should be rested and kept immobile to prevent further swelling or injury.

Which patient statement indicates understanding of the nurse's teaching about a new short-arm synthetic cast? A. "I can remove the cast in 4 weeks using industrial scissors." B. "I should avoid moving my fingers until the cast is removed." C. "I will apply an ice pack to the cast over the fracture site off and on for 24 hours." D. "I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast."

ANS: C Rationale: Ice application for the first 24 hours after a fracture will help reduce swelling and can be placed over the cast. The cast is typically removed in the outpatient setting. The patient should be encouraged to move the joints above and below the cast. Patients should not insert objects inside the cast.

Which information should the nurse include in discharge instructions for a patient with comminuted left forearm fractures and a long-arm cast? A. Keep the left shoulder elevated on a pillow or cushion. B. Avoid non-steroidal anti-inflammatory drugs (NSAIDs). C. Call the health care provider for numbness of the hand. D. Keep the hand immobile to prevent soft tissue swelling.

ANS: C Rationale: Increased swelling or numbness may indicate increased pressure at the injury, and the health care provider should be notified immediately to avoid damage to nerves and other tissues. The patient should be encouraged to move the joints above and below the cast to avoid stiffness. There is no need to elevate the shoulder, although the forearm should be elevated to reduce swelling. NSAIDs are appropriate to treat mild to moderate pain after a fracture.

A patient is being discharged 4 days after hip arthroplasty using the posterior approach. Which patient action requires intervention by the nurse? A. Using crutches with a swing-to gait B. Sitting upright on the edge of the bed C. Leaning over to pull on shoes and socks D. Bending over the sink while brushing teeth

ANS: C Rationale: Leaning over would flex the hip at greater than 90 degrees and predispose the patient to hip dislocation. The other patient actions are appropriate and do not require any immediate action by the nurse to protect the patient.

When a patient arrives in the emergency department with a facial fracture, which action should the nurse take first? A. Assess for nasal bleeding and pain. B. Apply ice to the face to reduce swelling. C. Use a cervical collar to stabilize the spine. D. Check the patient's alertness and orientation.

ANS: C Rationale: Patients who have facial fractures are at risk for cervical spine injury and should be treated as if they have a cervical spine injury until this is ruled out. The other actions are also necessary, but the most important action is to prevent cervical spine injury.

A patient is admitted to the emergency department with a left femur fracture. Which assessment finding by the nurse is most important to report to the health care provider? A. Bruising of the left thigh B. Reports of severe thigh pain C. Slow capillary refill of the left foot D. Outward pointing toes on the left foot

ANS: C Rationale: Prolonged capillary refill may indicate complications such as compartment syndrome. The other findings are typical with a left femur fracture.

A committee of musculoskeletal care nurses has been meeting to formulate policy changes regarding the proper method for providing pin site care. Based on current research findings, the nurses come to which conclusion? A. The critical period for infection control measures is up to 48 hours out from pin insertion. B. Pins located in areas of considerable soft tissue are at lowest risk for infection. C. Chlorhexidine 2 mg/mL solution is the cleanser of choice. D. Hydrogen peroxide is an acceptable skin cleanser.

ANS: C Rationale: Research supports that chlorhexidine 2 mg/mL solution is the most effective cleansing solution for pin site care. Incorrect: The critical period for infection control is after the first 48 to 72 hours, when drainage may be heavy; pin site care should be done daily. Pins located in areas with considerable soft tissue should be considered at greater risk for infection. The use of hydrogen peroxide is discouraged because it may cause damage to the healthy tissue surrounding the pin; it has also been associated with increased infection rates and the disruption of the skin's normal flora.

A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which assessment finding should indicate to the nurse a potential complication of the fracture? A. The patient states the pelvis feels unstable. B. The patient reports pelvic pain with palpation. C. Abdomen is distended, and bowel sounds are absent. D. Ecchymoses are visible across the abdomen and hips.

ANS: C Rationale: The abdominal distention and absent bowel sounds may be due to complications of pelvic fractures such as paralytic ileus or hemorrhage or trauma to the bladder, urethra, or colon. Pelvic instability, abdominal pain with palpation, and abdominal bruising would be expected with this type of injury.

A patient who slipped and fell in the shower at home has a proximal left humerus fracture immobilized with a sling. Which intervention should the nurse include in the plan of care? A. Use surgical net dressing to hang the arm from an IV pole. B. Immobilize the fingers of the left hand with gauze dressings. C. Assess the left axilla and change absorbent dressings as needed. D. Assist the patient in passive range of motion (ROM) for the right arm.

ANS: C Rationale: The axilla can become excoriated when a sling is used to support the arm, and the nurse should check the axilla and apply absorbent dressings to prevent this. A patient with a sling would not have traction applied by hanging. The patient will be encouraged to move the fingers on the injured arm to maintain function and to help decrease swelling. The patient will do active ROM on the uninjured side.

A high school teacher with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for arthroplasty of several joints in the left hand. Which patient statement to the nurse indicates a realistic expectation for the surgery? A. "This procedure will correct the deformities in my fingers." B. "I will not have to do as many hand exercises after the surgery." C. "I will be able to use my fingers with more flexibility to grasp things." D. "My fingers will appear more normal in size and shape after this surgery."

ANS: C Rationale: The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process. Hand exercises will be prescribed after the surgery.

After a motorcycle accident, a patient arrives in the emergency department with severe swelling of the left lower leg. Which action should the nurse take first? A. Elevate the leg on 2 pillows B. Apply a compression bandage. C. Assess leg pulses and sensation. D. Place ice packs on the lower leg.

ANS: C Rationale: The initial action by the nurse will be to assess circulation to the leg and observe for any evidence of injury such as fractures or dislocations. After the initial assessment, the other actions may be appropriate based on what is observed during the assessment.

A pedestrian who was hit by a car is admitted to the emergency department with possible right lower leg fractures. What initial action should the nurse take? A. Elevate the right leg. B. Splint the lower leg. C. Assess the pedal pulses. D. Verify tetanus immunization.

ANS: C Rationale: The initial nursing action should be assessment of the neurovascular condition of the injured leg. After assessment, the nurse may need to splint and elevate the leg based on the assessment data. Information about tetanus immunizations should be obtained if there is an open wound.

After the health care provider recommends 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? A. "You are upset, but you may lose the foot anyway." B. "Many people are able to function with a foot prosthesis." C. "Tell me what you know about your options for treatment." D. "If you do not want an amputation, you do not have to have it."

ANS: C Rationale: The initial nursing action should be to assess the patient's knowledge and feelings about the available options. Discussion of the patient's option to refuse the procedure, seriousness of the condition, or rehabilitation after the procedure may be appropriate after the nurse knows more about the patient's current knowledge and emotional state.

The nurse is caring for a patient who has a pelvic fracture and an external fixation device. How should the nurse perform assessment of pressure areas and provide skin care to the patient's back and sacrum? A. Ask the patient to turn to the side independently. B. Defer back assessment until the patient is ambulatory. C. Have the patient lift the back and buttocks using a trapeze. D. Roll the patient over to the side by pushing on the patient's hips.

ANS: C Rationale: The patient can lift the back slightly off the bed by using a trapeze. The patient may find it very difficult to turn to the side without assistance while in a fixator device. Delaying assessment and skin care may put the patient at risk for an undetected pressure injury. Pushing on the patient's hips may cause additional injury.

A patient is diagnosed with a compound fracture and is scheduled for immediate surgery. Which nursing diagnosis would have the highest priority in the immediate postoperative period? A. Impaired Transfer Ability B. Risk for Post-Trauma Syndrome C. Risk for Infection D. Risk for Falls

ANS: C Rationale: The patient with an open, compound fracture has multiple bone breaks penetrating through the skin and must be assessed and cared for vigilantly for signs of infection. Incorrect: The patient may have difficulty with transfers, but this is not the greatest priority. Depending on the reason for the injury and the patient's response, post-trauma syndrome may be applicable. This is not the greatest priority. The patient is at risk for a fall due to fracture, but this is not the highest priority.

The second day after admission with a fractured pelvis, a patient suddenly develops confusion. Which action should the nurse take FIRST? A. Take the blood pressure. B. Check the O2 saturation. C. Assess patient orientation. D. Observe for facial asymmetry.

ANS: C Rationale: The patient's history and clinical manifestations suggest a fat embolism. The most important assessment is oxygenation. The other actions are also appropriate but will be done after the nurse assesses O2 saturation.

Assessment of a patient post-arthroplasty reveals tachypnea, air hunger, hypoxia, O2 sat of 86%, declining mental status, and petechiae. What is the nurse's priority action? A. Apply oxygen at 3 to 4 liters /minute. B. Call a code for potential cardiac arrest. C. Prepare the patient for immediate intubation and mechanical ventilation with PEEP. D. Raise the head of the bed (HOB) and encourage coughing every hour.

ANS: C Rationale: The symptoms are related to severely compromised pulmonary status, probably acute respiratory distress syndrome (ARDS), which is related to a fat embolus blocking the pulmonary vessel and inactivating surfactant. Intubation and mechanical ventilation with PEEP (positive end-expiratory pressure) are needed to maximize air exchange and treat symptoms until the condition resolves. Incorrect: Application of oxygen would improve the availability of oxygen within the lungs but would not improve the perfusion at the alveolar capillary membrane. Calling for a code related to cardiac arrest is not appropriate at this time because the heart is not the problem; the pulmonary status should be addressed first. Raising the HOB will improve gas exchange slightly, but the problem is not expansion of the chest, so the condition will not improve.

A patient with carpal tunnel syndrome is being treated conservatively. Which information would the nurse provide? A. "Your wrist will be casted for the first 3 weeks, followed by a protective splint for the next 6 to 8 weeks." B. "Exercise your wrist for complete rotation and ROM every 4 hours while awake." C. "Wear a brace or wrist splint at night and during activities that aggravate the symptoms." D. "Wear an external hinge splint to support the wrist for several months."

ANS: C Rationale: Wearing a brace or splint will keep the wrist in a natural position during sleep and will offer support during activities that aggravate the symptoms. Incorrect: Wearing a cast for several weeks followed by a sprint applies to wrist arthroplasty, not endoscopic carpal tunnel release. Exercising the wrist will increase strain and cause more swelling that will delay the healing process. A hinge split is designed for elbow surgery, not for carpal tunnel syndrome.

Which finding in a patient with a Colles' fracture of the left wrist should the nurse identify as most important to communicate immediately to the health care provider? A. The patient reports severe pain. B. Swelling is noted around the wrist. C. Capillary refill to the fingers is slow. D. The wrist has a deformed appearance.

ANS: C Rationale: Swelling, pain, and deformity are common findings with a Colles' fracture. Prolonged capillary refill indicates decreased circulation and risk for ischemia. This is not an expected finding and should be immediately reported.

In which order should the nurse complete actions when caring for a patient in the emergency department who has a right leg fracture? (Put a comma and a space between each answer choice [A, B, C, D, E, F].) A. Obtain x-rays. B. Check pedal pulses. C. Assess lung sounds. D. Take blood pressure. E. Apply splint to the leg. F. Administer tetanus prophylaxis.

ANS: C, D, B, E, A, F Rationale: The initial actions should be to ensure adequate airway, breathing, and circulation. This should be followed by checking the neurovascular condition of the leg (before and after splint application). Application of a splint to immobilize the leg should be done before sending the patient for x-ray examination. The tetanus prophylaxis is the least urgent of the actions.

Which action should the nurse include in the plan of care for a patient who had a cemented right total knee arthroplasty? A. Avoid extension of the right knee beyond 120 degrees. B. Use a compression bandage to keep the right knee flexed. C. Teach about the need to avoid weight bearing for 4 weeks. D. Start progressive knee exercises to obtain 90-degree flexion.

ANS: D Rationale: After knee arthroplasty, active or passive flexion exercises are used to obtain a 90-degree flexion of the knee. The goal for extension of the knee will be 180 degrees. A compression bandage is used to hold the knee in an extended position after surgery. Protected weight bearing is typically not ordered after this procedure.

A young adult arrives in the emergency department with ankle swelling and severe pain after twisting an ankle playing basketball. Which prescribed action will the nurse implement first? A. Send the patient for ankle x-rays. B. Administer naproxen (Naprosyn). C. Give acetaminophen with codeine. D. Wrap the ankle and apply an ice pack.

ANS: D Rationale: Immediate care after a sprain or strain injury includes application of cold and use of compression to minimize swelling. The other actions should be taken after the ankle is wrapped with a compression bandage and ice is applied.

A patient experienced a cerebral spinal fluid leak after spinal surgery. The leak has just been treated with a blood patch. What is the nurse's priority action? A. Administering a bolus of IV fluids B. Positioning the patient on the left side C. Initiating strict isolation procedures D. Keeping the patient flat in bed for 2 hours

ANS: D Rationale: Keeping the patient flat in bed for 2 hours will allow the blood patch to clot and not migrate to other parts of the spine, thus allowing a seal to be formed to minimize/stop the leaking of cerebral spinal fluids. Incorrect: Administration of increased fluids is not indicated. Rapid fluid administration could increase the cerebral spinal pressure and increase the risk of rupture of the patch. Positioning the patient on the left side is not indicated. Sterile procedures and sterile dressings should minimize the risk of infection. Strict isolation procedures are not indicated.

A patient who has been casted for a fracture of the left ulna asks the nurse when the cast will come off. The nurse's response is based on knowledge that the cast will be removed when which physiologic parameter has been met? A. The remodeling phase of the bone healing process has been completed, allowing for application of mechanical stress. B. A cartilage collar can be clearly felt at the site of the original break. C. A specific amount of time has passed, predetermined by the severity of the break. D. The x-ray of the fractured bone shows that the ends are well joined.

ANS: D Rationale: Ossification is the final laying down of bone after the fracture has been bridged and the fragments are united. Mature bone replaces the callus, and the fracture site feels firm and appears united on radiograph. It is at this point that a cast may be removed. Incorrect: Remodeling of the bone occurs after the cast is removed. During cellular proliferation and callus formation, a cartilage "collar" is evident around the fracture site, but this does not signify that the bone has healed sufficiently to remove the cast. While the amount of time a fracture requires casting varies, the severity of the fracture is only one factor that is considered.

A patient has possible right carpal tunnel syndrome. What symptom should the nurse expect with a positive Tinel's sign? A. Weakness in the right little finger B. Burning in the right elbow and forearm C. Tremor when gripping with the right hand D. Tingling in the right thumb and index finger

ANS: D Rationale: Testing for Tinel's sign will cause tingling in the thumb and first three fingers of the affected hand in patients who have carpal tunnel syndrome. The median nerve does not innervate the right little finger or elbow and forearm. Tremor is not associated with carpal tunnel syndrome.

A patient is diagnosed with a sprained right ankle. The nurse instructs the patient on which common treatment of sprains? A. Application of a long leg cast B. Opioid pain medication C. Heat, rest, compression, and elevation D. Rest, ice, compression, and elevation

ANS: D Rationale: The interventions included in RICE therapy allow the injured muscle, ligament, or tendon to heal (rest), cause vasoconstriction and reduce pain (ice), decrease edema formation and pain (compression), and promote venous return to decrease edema and pain (elevation). Incorrect: Sprains are not treated with casts. Anti-inflammatory medications are best for sprains. Opioids are generally not required. Heat is contraindicated for treatment of sprains as it may increase swelling and pain.

A patient is to be discharged from the hospital 4 days after insertion of a femoral head prosthesis using a posterior approach. Which patient statement to the nurse indicates that additional teaching is needed? A. "I should not cross my legs while sitting." B. "I will use a toilet elevator on the toilet seat." C. "I will have someone else put on my shoes and socks." D. "I can sleep in any position that is comfortable for me."

ANS: D Rationale: The patient needs to sleep in a position that prevents excessive internal rotation or flexion of the hip. The other patient statements indicate the patient has understood the teaching.

The nurse cannot palpate a patient's pedal pulse following an open reduction internal fixation (ORIF) procedure for a fractured tibia. Which action is the priority intervention? A. Check the lower extremity for pallor. B. Notify the surgeon of the problem. C. Assess the patient's pain rating. D. Use a Doppler to find the pedal pulse.

ANS: D Rationale: To assess the circulation when the pulse is not palpable, the nurse should use a Doppler. Incorrect: Pallor is not the best indicator of circulation status. Notifying the surgeon, if indicated, should occur once all assessment data are collected. A pain rating is not the best indicator of circulation status.

A patient wearing a long leg cast has assessment findings of compartment syndrome in the extremity. The nurse demonstrates understanding of the complication and its specific treatment by gathering which equipment? A. Pillows to elevate the leg B. A percussion hammer C. Buck's traction equipment D. Ace bandages

ANS: D Rationale: Compartment syndrome occurs when excess pressure in a limited space constricts the structures within a compartment, reducing circulation to muscles and nerves. With increased edema, this event threatens the viability of the limb and increases the risk of sepsis. Treatment can include removing the cast entirely or bivalving it (splitting it apart with a cast cutter) and securing the two sides with Ace wraps, tape, or Velcro straps. Incorrect: Elevating the leg above the heart would compromise circulation. At this point the diagnosis has been made; further assessment is not indicated and would waste time. Buck's traction is not a priority in the current care of this patient.

A factory line worker has repetitive strain syndrome in the left elbow. What topic should the nurse plan to include in patient teaching? A. Surgical options B. Elbow injections C. Wearing a left wrist splint D. Modifying arm movements

ANS: D Treatment for repetitive strain syndrome includes changing the ergonomics of the activity. Elbow injections and surgery are not initial options for this type of injury. A wrist splint might be used for hand or wrist pain.