Prep U: chapter 37

A client who has undergone a lower limb amputation is preparing to be discharged home . What outcome is necessary prior to discharge ?

Client can demonstrate safe use of assistive devices

A client who has undergone a lower limb amputation is preparing to be discharged home . What outcome is necessary prior to discharge ?

Client can demonstrate safe use of assistive devices .

An x - ray demonstrates a fracture in which a bone has splintered into several pieces . Which type of fracture is this ?

Comminuted

Two days after application of a cast to treat a fractured femur , the client reports severe , deep , and constant pain in the leg . What will the nurse suspect ?

Compartment syndrome

A client comes to the emergency department and reports localized pain and swelling in the lower leg . Ecchymotic areas are noted . History reveals that the client got hit in the leg with a baseball bat . What will the nurse most likely suspect ?

Contusion

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

Difficulty lying on affected side

The nurse caring for a client , who has been treated for a hip fracture , instructs the client not to cross their legs and to have someone assist with tying their shoes . Which additional instruction should the nurse provide to client ?

Do not flex the hip more than 90 degrees

Which nursing intervention is appropriate for a client with a closed - reduction extremity fracture ?

Encourage participation in ADLS

A 68 - year - old client who had a below - the - knee amputation is to be discharged because their healing is almost complete . Which of the following would be most important for the nurse to discuss with this client ?

Exploring factors related to the client's home environment

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

Greenstick

A client in pelvic traction needs circulatory status assessed . How should the nurse assess for a positive Homans ' sign ?

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

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

To reduce the incidence of complications in a client in traction , which intervention should be included in the care plan ?

Increase fiber intake

A client experienced an open fracture to the left femur during a horse - riding accident . For which complication is this client at highest risk ?

Infection

Question Which nursing diagnosis takes highest priority for a client with a compound fracture ?

Infection related to effects of trauma

The nurse is caring for a client with a spica cast . What is the nurse's priority intervention ?

Keep the cast clean and dry .

A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip . The nurse should include which intervention in the postoperative care plan ?

Keeping a pillow between the client's legs at all times

A client is seen in the orthopedic clinic for reports 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 arthroplasty

A nurse is caring for a client who recently underwent a total hip replacement . What is the best action by the nurse for client care ?

Limit hip flexion of the client's hip when the client sits up .

Which factor inhibits fracture healing ?

Local malignancy

A client with a fractured femur is in balanced suspension traction . The client needs to be repositioned toward the head of the bed . During repositioning , what should the nurse do ?

Maintain consistent traction tension while repositioning .

A client has undergone an external fixation . Which actions would be the priority for this client ?

Maintaining pin care

A client's fracture was reduced by surgically exposing the bone and realigning it . What type of treatment does the nurse identity this as ?

Open reduction

The nurse is caring for a client who underwent a total hip replacement yesterday . What should the nurse do to prevent dislocation of the new prosthesis ?

Protect the affected leg from internal rotation .

A client with a traumatic amputation of the right lower leg is refusing to look at the leg . Which action by the nurse is most appropriate ?

Provide feedback on the client's strengths and available resources

The nurse is caring for a client who had a total hip replacement . What lethal postoperative complication should the nurse closely monitor for ?

Pulmonary embolism

A nurse is giving instructions to a client who's going home with a leg cast . Which teaching point is most critical ?

Reporting signs of impaired circulation

Which is an inaccurate principle of traction ?

Skeletal traction is interrupted to turn and reposition the client .

Which principle applies to the client in traction ?

Skeletal traction is never interrupted .

A client sustains an injury to the ligaments surrounding a joint What will the nurse identify this injury as ?

Sprain

Which term refers to an injury to ligaments and other soft tissues surrounding a joint ?

Sprain

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 .

to support their arm A nurse is preparing to discharge an emergency department client who has been fitted with a sling after a clavicle fracture . What should the nurse instruct the client to do ?

Use the arm for light activities within the range of motion .

The nurse is helping to set up Buck's traction on an orthopedic client . How often should the nurse assess circulation to the affected leg ?

Within 30 minutes , then every 1 to 2 hours

A client sustains an injury to the left ankle in a fall . There was immediate swelling and pain from the injury , and the client was taken to the local emergency department . What initial test does the nurse anticipate the health care provider will order to rule out a fracture ?

X - ray

Which is not one of the general nursing measures employed when caring for the client with a fracture ?

cranial nerve assessment

A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain . After radiographs indicate intact yet malpositioned bones , what repair would the health care provider perform ?

joint manipulation and immobilization

A fracture is considered pathologic when it

occurs through an area of diseased bone .

Report this A variety of complications can occur after a leg amputation . Which is not a possibility in the immediate postoperative period ?

osteomyelitis

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise . During discharge preparation , the nurse should provide which instruction ?

" Apply ice packs for the first 24 to 48 hours , then apply heat packs . "

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 increases range of motion of the joint . "

A client asks the nurse why their residual limb cannot be elevated on a pillow . What is the best response by the nurse ?

" Elevating the leg might lead to a flexion contracture . "

A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm . The client also has a long laceration that has been sutured in the same area . The client asks the nurse why a splint is applied and not a cast . What is the best explanation by the nurse ?

" We will need to monitor the status of the laceration to be sure it does not get infected . "

A client with a fractured femur is admitted to the nursing unit . Which assessment finding requires follow up by the nurse ? Select all that apply .

-" I cannot seem to catch my breath . " -" I have a pins - and - needles sensation in my toes . " -Dorsoplantar weak and unequal bilaterally -T 101.2 degrees F : HR 110 ; RR 28 ; pulse oximetry 90 %

A continuous passive motion ( CPM ) machine is used to promote healing and flexibility in the knee and hip joint and increase circulation to the operative area . What is true about the use of CPM ?

-The health care provider orders the amount of extension and flexion produced by the machine . -The health care provider orders the frequency of use of the machine . -The amount of flexion for clients with hip replacements should never exceed 30 . degrees in the CPM machine .

The client displays manifestations of compartment syndrome . What treatment will the nurse expect the client to be scheduled for ?

A fasciotomy

Two days after surgery to amputate the left lower leg , a client reports pain in the missing extremity . Which action by the nurse is most appropriate ?

Administer medication , as ordered , for the reported discomfort .

A nurse is caring for a client who is in skeletal traction . To prevent the complication of skin breakdown in a client with skeletal traction , what action should be included in the plan of care ?

Assess the pin insertion site every 8 hours .

A nurse is caring for a client placed in traction to treat a fractured femur . Which nursing intervention has the highest priority ?

Assessing the extremity for neurovascular integrity

Which action would be most important postoperatively for a client who has had a knee or hip replacement ?

Assisting in early ambulation .

The orthopedic surgeon has prescribed balanced skeletal traction for a client . What advantage is conferred by balanced traction ?

Balanced traction allows for greater client movement and independence than other forms of traction

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 ?

Better molding to the client

A client has stepped in a hole in the yard , causing an ankle injury . The ankle is edematous and painful to palpation . How long should the nurse inform the client that the acute inflammatory stage will last ?

Between 24 and 48 hours .