NSG 124 Ortho EAQ

While providing care for a client with a second-degree left ankle sprain, the nurse raises the injured part above heart level. Which statement provides the reason behind this nursing intervention?

A client with a second-degree sprain may have a deeply torn ankle ligament with swelling and tenderness. Elevation of the injured lower limb above heart level helps mobilization of the excess fluid from the area and prevents further edema. Strengthening exercises help build bone density and muscle strength and significantly reduce the risk of sprains and strains. Cryotherapy and adequate rest help reduce pain by reducing the transmission and perception of pain impulses.

A 90-year-old resident fell and fractured the proximal end of the right femur. The surgeon plans to reduce the fracture with an internal fixation device. Which general fact about the older adult would the nurse consider when caring for this client?

Aging causes a lowering of the physiological coping reserve of various systems of the body. The pain threshold increases with aging. There are many etiologies for confusion (e.g., medication intolerance, altered metabolic state, unfamiliar surroundings). As individuals age they become more entrenched in ideas, environment, and objects that are familiar, and thus do not tolerate change well.

Which clinical sign would the nurse expect to identify when assessing a client with a fracture of the femoral neck?

As a result of contraction and pulling of the muscles on the two bone fragments, there is a characteristic shortening of the femur with external rotation of the extremity. Lateral motion of the leg does not occur; the leg externally rotates. The extremity externally rotates as the muscles contract; shortening, not lengthening, occurs.

A client has closed fractures of the right femur and tibia with multiple soft-tissue contusions. Which action would the nurse plan to take?

Assess: Identifying the status of the damage is the priority. Before a treatment protocol is determined, the presence of nerve or vascular damage and compartment syndrome must be identified. False reassurance is never appropriate. Skeletal traction is used rarely. Closed fractures in the absence of soft tissue damage generally are reduced by manipulation. Closed fractures with soft tissue damage may require an external fixation device to reduce the fracture, immobilize the bone, and allow for treatment of the soft tissue damage. Preparing the client for surgery is premature; more data are necessary before a treatment option is determined.

Which would the nurse recommend to a client with bursitis of the left knee?

Bursitis is an inflammation of the bursal sac surrounding the joint. Rest, use of a compression splint, and taking NSAIDs can help relieve bursitis. Use of an ice pack (not a heat pack) can also help with pain. Gentle range-of-motion exercises are not indicated for bursitis.

A client experiences a fat embolism syndrome (FES) while hospitalized after an extensive motor vehicle accident. Which anatomical part of the bone depicted in the figure is responsible for the client's condition?

Choice B depicts spongy cancellous tissue. Softer cancellous tissue contains large spaces or trabeculae, filled with red and yellow marrow. Yellow marrow contains fat cells that may be dislodged and enter the bloodstream, which can cause FES. Choice A indicates articular cartilage, which is a smooth white tissue that covers the ends of bones. Choice C indicates compact bone, which is hard due to inorganic calcium salt deposits. Choice D depicts bone cells (osteocytes) present in the deepest layer of the periosteum.

Which client statement indicates effective learning of their osteomyelitis treatment with ciprofloxacin therapy?

Ciprofloxacin causes adverse effects like formation of whitish-yellow or curd-like lesions in the mouth and itching in the perianal area. The client's statement regarding the primary health care provider should be contacted in case of white patches in the mouth indicates effective learning. Clients should change their dressings once soiled, not weekly. The client must take the antibiotic even after the symptoms have subsided and feels better. If the client abruptly discontinues this medication, medication resistance may develop. There are no restrictions as to who should change the dressing; the client can also change the dressing as needed.

Which motions would the nurse perform on a client's ankle to demonstrate full range-of-motion?

Dorsiflexion, plantar flexion, eversion, and inversion movements include all possible ranges of motion for the ankle joint. Although the ankle can be moved in a circular motion, flexion and extension more specifically are called dorsiflexion and plantar flexion in relation to the ankle. Also, eversion and inversion should be done when manipulating the ankle. The ankle cannot be abducted or adducted but can be inverted and everted. Pronation, supination, rotation, and extension refer to the upper extremities.

Which clinical indicator would the nurse identify when a client has a fat embolus, but would not be present with a thromboembolus?

Fat emboli cause capillary fragility; rupture of capillary walls results in pinpoint red spots (petechiae) on the chest and conjunctiva of the eye. Anxiety occurs in both fat embolism and thromboembolism. There often is a feeling of dread or impending doom. Restlessness and confusion from cerebral hypoxia occur in both fat embolism and thromboembolism. The arterial oxygen may be decreased in both fat embolism and thromboembolism.

A client sustains a fractured right femur after an automobile accident and is admitted to the hospital's emergency department. Which assessments would the nurse make?

Monitoring a pedal pulse will assess circulation to the foot. Palpate the pulse distal to the injury. The inability to wiggle the toes indicates neurological impairment. The presence of numbness or tingling indicates that paresthesia is present, indicating neurological damage. Turning the client to the side-lying position or having the client bear weight on the affected leg is contraindicated if a fracture of the femur is suspected; moving this client can cause further trauma.

Which assessment of the affected leg would the nurse make after a client has an open reduction internal fixation of a fractured hip?

Monitoring the mobility of the toes assesses neural integrity distal to the surgical site; this is part of a neurovascular assessment. The femoral artery is not assessed, because it is not distal to the surgical site. No pin is present with an open reduction and internal fixation of a fractured hip. An assessment of range of motion of the knee may cause flexion of the hip, which is contraindicated.

Which clinical manifestations would lead the nurse to contact the health care provider regarding the potential development of acute osteomyelitis?

Osteomyelitis is the infection of bone caused by bacteria, viruses, or fungi. The symptoms of acute osteomyelitis are fever (temperature above 101°F [38.3°C]), erythema, and tenderness near the affected area. The symptoms of chronic osteomyelitis are the presence of foot ulcers and drainage from the affected area.

The nurse advises a client recovering from a musculoskeletal injury to increase intake of which nutrient?

People suffering from a musculoskeletal injury should be advised to increase their intake of protein to promote tissue healing and recovery. Also important are adequate intake of fluids, fiber, and minerals such as calcium, phosphorus, and magnesium. Fat, sodium, and vitamin A are not specifically beneficial for musculoskeletal injuries.

A client returns from surgery, after a right below-the-knee amputation, with the residual limb straight, but elevated on a pillow to prevent edema. In which position would the nurse place the client after the first postoperative day?

Positioning the client in the prone position for short periods helps prevent hip flexion contractures. Do not immobilize the client's residual limb, but do not keep the joint bent for prolonged periods. Begin exercises to prevent contractures as soon as possible. Positioning the client in the right side-lying position can cause trauma to the incision site and should be avoided. Do not elevate the client's residual limb for more than 48 hours because hip flexion contractures can result.

A client is scheduled for a closed magnetic resonance imaging test (MRI) for a knee problem. The client states, "I'm a little scared of small places." Which response would the nurse make?

The response "Mild sedation is available if you are anxious about lying in a confined area" acknowledges the client's concern and offers a potential intervention that may reduce the client's anxiety. "Maybe it is best that you not have this test. Let me talk with your primary health care provider" is an inappropriate response, because the test may be significant for diagnosing the client's health problem. If necessary, an open MRI may be performed; however, a closed, high-magnet scanner may produce more significant results than will be produced by an open, low-magnet scanner. Although the response "We will make sure that all metal objects are removed from the immediate area to avoid injury" is a true statement, this response may increase the client's anxiety and does not address the concern of a small space. The response "You will be able to communicate with us by an intercom system, so you have nothing to worry about" dismisses the client's concerns and provides false reassurance.

Which instruction would the nurse provide to an older client using ice and heat to treat pain from back strain?

To prevent skin damage, ice and heat should only be applied for 20- to 30-minute intervals. Clients should be instructed to shift positions every hour to prevent skin breakdown. Ice should be used the first 24 to 48 hours followed by heat. Ice should never be directly applied to the skin as it can cause injury to the tissue. The client can take ibuprofen if approved by the health care provider.

A client with a fractured hip is placed in traction until surgery can be performed. Which goal would the nurse explain as the purpose of the traction?

Traction may be used in the treatment of a fractured hip to align the bones (reduction of fracture). If such traction is not employed, the muscles may go into spasm, shifting the bone fragments and causing pain. Traction is a temporary measure before surgery; contractures result from a shortening of the muscles by prolonged immobility. Although the affected extremity must be properly aligned, turning and moving the client can and should be done. External rotation is contraindicated and prevented by the use of positioning aids.

Which client statement indicates the need for further teaching about the traction device after a major fracture?

Traction uses counterweights to gently pull (not push) the affected extremity to realign it. It must be applied continuously to be effective. Weights of 5 to 45 pounds are used in skeletal traction to maintain the proper alignment. Risks associated with traction include infection at the insertion site and the general risks of immobility.

The client asks the nurse the advantage of having an immediate prosthesis after a below-the-knee amputation. Which advantage would the nurse explain?

Without a prosthesis, a walker or crutches are necessary, and these require readjustment of weight bearing on one leg. Early use of a prosthesis does not affect the incidence of phantom limb pain, which occurs in about 10% of clients with amputations. Early use of a prosthesis has no effect on wound infection. Although true, fitting of the prosthesis before discharge is not the major purpose; a prosthesis can be fitted easily after discharge when the residual limb has healed completely and is no longer edematous.

Which key factor assists the nurse in assessing how a client will cope with the body image change after an above-the-knee amputation?

personal perception of the change