Week 14 AQ

An injured soldier had an amputation of the left leg and is reporting shooting pain and heaviness in the area of the missing leg. What would be the best response by the nurse for this patient? 1 Use mirror therapy 2 Give opioid analgesics 3 Rebandage the residual limb 4 Show the patient that the leg is gone

1- Correct

The nurse is caring for a patient with a fracture who has a Buck's traction boot in place. Which complication is prevented by the use of the boot? 1 Muscle spasms 2 Posttraumatic arthritis 3 Intraarticular adhesions 4 Extraarticular adhesions

1- Correct Traction devices apply a pulling force on a fractured extremity in order to realign the bone. A Buck's traction boot is a type of skin traction used to immobilize a fracture, prevent hip flexion contractures, and reduce muscle spasms. Continuous passive motions (CPM) decrease the incidence of posttraumatic arthritis. CPM is used for various joints, such as the knee and shoulder, to prevent intraarticular and extraarticular adhesions. Text Reference - p. 1514

An osteoarthritis patient with consistent knee pain undergoes an osteotomy. What would be an expected finding during the postoperative period? 1 Relief from pain 2 Decreased mobility 3 Free movement of the joint 4 Deformity correction of the joint

1- Correct When an osteotomy is performed on a patient with osteoarthritis, surgery provides relief from the pain. Mobility is improved after the surgery. A joint cannot be moved as freely after surgery as compared to before the surgery. Deformity can be corrected with a replacement surgery. Text Reference - p. 1534

Which statement indicates specific postoperative care for a patient who underwent finger joint arthoplasty? 1 "The operated extremity should not be elevated above heart level." 2 "The operated extremity should have a bulky dressing and must be elevated." 3 "The patient's upper extremities should be assessed for neurovascular changes." 4 "Hand exercises should be performed for one to two weeks after discharge."

2- Correct During the postoperative care of the finger joint, the extremity should is kept elevated with bulky dressing to increase venous pressure. The operated extremity should be elevated above heart level to prevent edema formation. Assessment of neurovascular changes in both the upper extremities is to compare both the extremities. This is done to obtain accurate assessment of the operated extremity is general postoperative care followed after an orthopedic surgery. The patient is advised to perform hand exercises for at least 10 to12 weeks after discharge. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. Text Reference - p. 1535

Which part of the joint enables progression of inflammation to other parts of the joint? 1 Tendons 2 Ligaments 3 Articular cartilage 4 Synovial membrane

4- Correct

The patient is brought to the emergency department after a car accident and has a femur fracture. What nursing intervention should the nurse implement to prevent a fat embolus in this patient? 1 Administer enoxaparin 2 Provide range of motion exercises 3 Apply sequential compression boots 4 Immobilize the fracture preoperatively

4- Correct To prevent fat emboli, the nurse immobilizes the long bone to reduce movement of the fractured bone ends and decrease the risk of a fat embolus from the bone before surgical reduction. Enoxaparin is used to prevent blood clots, not fat emboli. Range of motion and compression boots will not prevent a fat embolus in this patient. Text Reference - p. 1523

The nurse is completing a neurovascular assessment on the patient with a tibial fracture and a cast. The feet are pulseless, pale, and cool. The patient says they are numb. What should the nurse suspect is occurring? 1 Paresthesia 2 Pitting edema 3 Poor venous return 4 Compartment syndrome

The nurse should suspect compartment syndrome with one or more of the following six Ps: paresthesia, pallor, pulselessness, pain distal to the injury and unrelieved with opioids, pressure increases in the compartment, and paralysis. Although paresthesia and poor venous return are evident, these are just some of the manifestations of compartment syndrome. Pitting edema is not evident. Text Reference - p. 1522

A nurse is attending a patient who has sustained a fracture of the femur. What interventions should the nurse perform to ensure a healthy diet for optimal healing of the injured tissues? Select all that apply. 1 Include 1g/kg of protein daily. 2 Increase calcium-rich foods in the diet. 3 Decrease magnesium- and phosphorus-rich foods. 4 Include foods rich in vitamins C and D. 5 Decrease the intake of foods rich in B vitamins.

1, 2, 4- Correct Proper nutrition is an essential component of the healing process in injured tissue. An adequate energy source is needed to promote muscle strength and tone, build endurance, and provide energy for ambulation and maintaining a proper gait. The patient's dietary requirements must include adequate protein, usually 1 g/kg of body weight. The calcium intake should be increased, because immobility and bone healing increase calcium needs. Intake of vitamins C and D should be increased, because these are necessary for optimal soft tissue and bone healing. Magnesium and phosphorus are also necessary for the healing process, and their intake should be increased. B vitamins also aid in the healing of soft tissues and bones. Text Reference - p. 1517

A patient with a hip fracture has been treated with insertion of a prosthesis. What findings indicate dislocation of this prosthesis? Select all that apply. 1 Limb shortening 2 Edema of the limb 3 A lump in the buttock 4 External rotation of the limb 5 Weak pulse in the limb

1, 3, 4- Correct Symptoms such as sudden severe pain, a lump in the buttock, limb shortening, and external rotation indicate prosthesis dislocation. This requires a closed reduction with conscious sedation or open reduction to realign the femoral head in the acetabulum. Edema of the limb and a weak pulse can be due to other causes, such as compartment syndrome. Text Reference - p. 1526

A patient experiences a nondisplaced fracture. What condition can potentially displace the fracture in the patient? 1. Crepitation 2. Ecchymosis 3. Muscle spasm 4. Edema and swelling

3- Correct Muscle spasms may displace previously nondisplaced fractures. Crepitation may increase the chance of nonunion of the bones. Ecchymosis is discoloration of the skin that may appear immediately after the injury and distal to the injury. Edema and swelling indicate occluded circulation. Text Reference - p. 1512

Which type of surgical repair is performed during hemiarthroplasty? 1 Reshaping of the femoral head 2 Repair with internal fixation devices 3 Replacement of both femur and acetabulum 4 Replacement of part of the femur with prosthesis

4- Correct Hemiarthroplasty is a surgical replacement of part of a joint. Replacement of part of the femur with a prosthesis is known as hemiarthroplasty. Reshaping of the femoral head is done during hip resurfacingin which the femoral head is reshaped rather than replaced. Repair of the joints with internal fixation is done through devices such as pins, plates, and intramedullary rods that are inserted into the joint to attain the correct bone alignment. The replacement of both femur and acetabulum is performed during a total hip arthroplasty. Text Reference - p. 1534

A patient with osteoarthritis is preparing for a total left-knee arthroplasty. The nurse assesses the patient carefully to be sure that there is no evidence of which sign in the preoperative period? 1 Immobility 2 Pain 3 Inflammation 4 Infection

4- Correct It is critical that the patient be free of infection before a total knee arthroplasty. An infection in the joint could lead to even greater pain and joint instability, requiring extensive surgery. For this reason, the nurse monitors the patient for signs of infection, such as redness, swelling, fever, and increased white blood cell count. Pain, immobility, and inflammation are common findings in the patient with osteoarthritis and would not be contraindications to surgery. Text Reference - p. 1535

A patient with a fracture of the right tibia is scheduled for application of a cast. What is the correct order of applying the materials, from inside to outside? 1. Place padding over the stockinette. 2. Immerse plaster of Paris in warm water. 3. Cover the affected part with a stockinette. 4. Wrap plaster of Paris around the affected part.

To apply a cast on an extremity, first cover the affected part with a stockinette that is cut longer than the extremity. Then place padding over the stockinette, with the bony prominences given extra padding. If the casting material used is plaster of Paris, it is usually immersed in warm water before being wrapped and molded around the affected part. The number of layers of plaster bandage and the technique of application determine the strength of the cast. The plaster sets within 15 minutes. Text Reference - p. 1520

After a motor vehicle crash, a patient has a dislocated right hip joint, and the bone is exposed in the right thigh. What type of fracture should the nurse document? Select all that apply. 1 Open 2 Comminuted 3 Closed 4 Displaced 5 Greenstick

1,2,3- Correct In this case, the bone is exposed, and therefore it is an open fracture. Comminuted fractures have two or more fragments of bones. Fractures can be classified as displaced or nondisplaced. In a displaced fracture, the two ends of the broken bone are separated from one another and are out of their normal positions. This fracture is not a closed one, because the fractured bone is exposed through soft tissue injury. Greenstick fracture is a type of fracture in which the periosteum is intact across the fracture and the bone is still in alignment. Test-Taking Tip: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question. Text Reference - p. 1511

Which statement given by the nurse is true about the removal of degenerated menisci from a joint? 1 "The surgical procedure does not require hospitalization." 2 "Activity is restricted until 72 hours after the surgical procedure." 3 "Passive flexion exercises with a continuous passive motion are recommended." 4 "Perform an isometric muscle-strengthening exercise regimen within the confines of immobilization devices."

1- Correct

Which type of fracture is most common in older adults? 1. Hip fracture 2. Colles' fracture 3. Pelvic fracture 4. Fracture of the humerus

1- Correct

A patient experiences an unstable wrist fracture. Which type of cast will be most beneficial for the patient? 1. Long arm cast 2. External fixation 3. Short arm cast, restricting motion at the wrist and elbow 4. Short arm cast, providing wrist immobilization and unrestricted elbow motion

1- Correct A patient who has an unstable wrist fracture needs restricted movement of the wrist and elbow that extends to the proximal humerus. This is provided by a long arm cast. Simple fractures and complex fractures with extensive soft tissue damage, nonunion or malunion, and limb lengthening can be done through external fixation, which is often used in an attempt to salvage extremities. By definition, a short arm cast facilitates unrestricted elbow motion, which is harmful for the patient with an unstable wrist fracture. Text Reference - p. 1515

A patient has undergone amputation just below the level of the elbow in the right upper limb. The patient states that there is still the sensation of pain in the missing portion one day after surgery. What should the nurse inform the patient? 1 It is normal to feel this way. 2 You are having illusions. 3 You are experiencing delusions. 4 You are having hallucinations.

1- Correct After an amputation, the patient may still feel the presence of the amputated part. The nurse should explain to the patient that it is normal to feel this way. This phenomenon, termed phantom limb sensation, occurs in many amputees. Such a sensation is not illusion, delusion, or hallucination. Text Reference - p. 1533

The registered nurse teaches a student nurse about care of a patient with a fracture of the humerus, compartment syndrome, and a plaster cast in place. The student nurse provides discharge education to the patient. Which statement made by the student nurse needs correction? 1. "Elevate the extremity above the heart level." 2. "Use a hair dryer on a low setting to dry the cast thoroughly." 3. "Control the itching sensation by using a hair dryer on a cool setting at the site of itching." 4. "Avoid covering the cast with plastic for extended periods of time."

1- Correct Elevation of the extremity above the heart level is contraindicated for patients with compartment syndrome, which is a painful condition that occurs when the pressure within the muscle increases to dangerous levels. If the cast gets wet by mistake, it should be dried thoroughly using a hair dryer on the low setting. Itching is a common sensation experienced by patients and can be controlled by using a hair dryer on the cool setting instead of using hard objects to scratch the area. The patient should not cover the cast with plastic for prolonged periods. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 1520

Which complication is being addressed when the nurse assists the patient with physical therapy exercises following shoulder surgery? 1 Fibrosis 2 Fat embolism 3 Thromboembolism 4 Compartment syndrome

1- Correct Frozen shoulder, or fibrosis of the shoulder capsule, can be prevented by physical therapy after the surgery. Drug therapy is a management technique for fat embolism. Anticoagulants are used as both prevention and treatment for thromboembolism. Compartment syndrome can be prevented through proper assessment techniques and rapid surgical intervention. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 1535

A newborn baby has sustained an uncomplicated midshaft fracture of the femur. In how many weeks will the fracture heal? Record your answer as a whole number. 1 3 weeks 2 7 weeks 3 10 weeks 4 20 weeks

1- Correct Many factors influence fracture healing, including displacement, the site of the fracture, the blood supply to the area, and any immobilization and internal fixation devices (e.g., screws, pins). Healing time for fractures increases with age. An uncomplicated midshaft fracture of the femur heals in 3 weeks in a newborn and in 20 weeks in an adult. Text Reference - p. 1513

A patient had a surgical procedure on the left knee one day ago with the insertion of a hemovac for drainage. What is the role of the nurse in postoperative management? Select all that apply. 1 Monitoring vital signs 2 Performing neurovascular assessments 3 Instructing the patient to restrict water intake 4 Measuring the volume of drainage 5 Retrieving blood from the joint space

12,4- Correct In general, postoperative nursing care and management are directed toward monitoring vital signs. Frequent neurovascular assessments of the affected extremity are necessary to detect early and subtle neurovascular changes. Closely monitor any limitations of movement. Pain and discomfort can be minimized through proper alignment and positioning. Carefully observe dressings or casts for any signs of bleeding or drainage. Report any significant increase in the size of the drainage area. If a wound drainage system is in place, as in this case, regularly measure the volume of drainage and assess the patency of the system, using aseptic technique to avoid contamination. The patient's water intake is not restricted. The patient may receive an auto transfusion of blood. However, the retrieval of blood from the joint space is done by the specialists. Text Reference - p. 1519

A patient is brought to the hospital with bloodstains on clothing and active bleeding from the nose, with deformity of the right arm. Prioritize the initial interventions to be done in this case. 1. Check for pulse rate. 2. Check if there is blood in the mouth. 3. Assess the neurovascular status of the right arm. 4. Check for respiratory rate.

2, 4, 1, 3- Correct Emergency management of any injury involves assessment of air way (A), breathing (B), and circulation (C), in that order. Therefore for this patient the attending nurse should first check for any blood in the mouth blocking the airway, then check for respiratory effort to see if the patient is breathing, then check for a pulse to see if circulation of blood is normal, and then assess the neurovascular status of the affected limb (in this case, the right arm). Test-Taking Tip: What happens if you find yourself in a slump over the examination? Take a time-out to refocus and reenergize! Talk to friends and family who support your efforts in achieving one of your major accomplishments in life. This effort will help you regain confidence in yourself and get you back on track toward the realization of your long-anticipated goal. Text Reference - p. 1529

An occupational health nurse is conducting an awareness program to prevent limb amputations. When explaining the risk of amputation, which population group would the nurse indicate as at high risk for amputation? Select all that apply. 1 Patients with ulcerative colitis 2 Patients with diabetes mellitus 3 Patients with myasthenia gravis 4 Patients with chronic osteomyelitis 5 Patients with peripheral vascular disease

2, 4, 5- Correct Patients with diabetes mellitus, chronic osteomyelitis, or peripheral vascular disease are predisposed to increased risk of amputation. Controlling these diseases can eliminate or delay the need for amputation. Ulcerative colitis and myasthenia gravis do not lead to gangrene in the limbs or to amputation. Text Reference - p. 1531

A patient with a hip fracture has symptoms such as severe pain and tenderness around the fractured area. What is the prioritized treatment goal following hip arthroplasty? 1 Avoiding adduction of hip 2 Receiving relief from the pain 3 Participating in exercise therapy 4 Understanding the treatment plan

2- Correct After a hip arthroplasty, the priority of the treatment is to relieve pain to the patient's stated comfort goal. Abduction, not adduction, of the hip should be maintained postoperatively to avoid displacement of the hip. A physical therapist introduces exercise therapy gradually to restore muscle tone. Quadriceps and muscles about the hip are essential to improve function and range of motion. It is important for the patient to understand and follow the prescribed plan of treatment for a speedy recovery. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.

Which body part of the patient is at risk for superior mesenteric artery syndrome when sustaining a fracture? 1. Knee 2. Vertebrae 3. Lower extremity 4. Upper extremity

2- Correct In stable spine injuries, a thoracic or lumbar spine body jacket brace is used for immobilization and support. Superior mesenteric artery syndrome occurs if the brace is applied too tightly, compressing the superior mesenteric artery against the duodenum. Knee injuries, lower extremity injuries, and upper extremity injuries do not require a thoracic or lumbar spine body jacket brace and, therefore, are not associated with mesenteric artery syndrome. Text Reference - p. 1516

What is the duration of hospitalization for hip arthroplasty? 1 One to two days 2 Three to five days 3 Two to four weeks 4 Six to twelve weeks

2- Correct The duration of a hospital stay after hip arthroplasty is three to five days, depending on the patient's course and need for physical therapy. The patient would not recover in one or two days. Two to four weeks or six to twelve weeks of hospitalization would be unnecessary. Text Reference - p. 1535

The nurse is completing an admission history for a patient with osteoarthritis who has been admitted for a knee arthroplasty. When the nurse asks the patient why the procedure is being performed, what does the nurse anticipate the patient will state? 1 "I have a fractured patella." 2 "I have chronic knee pain." 3 "I have frequent and multiple falls." 4 "My knee needs to be totally immobilized."

2- Correct The most common reason for knee arthroplasty is debilitating joint pain despite attempts to manage it with exercise and drug therapy. A fractured patella would be the result of a fall or trauma, not osteoarthritis. Frequent and multiple falls are not associated with osteoarthritis, and although pain is chronic, the knee will not be completely immobilized. Text Reference - p. 1535

The nurse is providing postoperative care to a patient who underwent surgical repair of a fractured hip two days ago. Which assessment finding indicates the need for immediate nursing action and intervention? 1. Pain at the surgical site 2. Sudden shortness of breath 3. Serosanguineous wound drainage 4. Limited range of motion of the affected leg

2- Correct The sudden onset of shortness of breath could be an indication of fat embolism syndrome, a potentially fatal complication of long bone fractures. Pain at the surgical site, serosanguineous wound drainage, and limited range of motion of the affected leg are all expected findings in a patient who has just undergone repair of a fractured hip. Text Reference - p. 1523

A nurse is completing the discharge sheet for a patient with hip fracture, who has been treated by insertion of a prosthesis using a posterior approach. What instructions should be given to this patient before discharge? Select all that apply. 1 An adaptive device is not necessary for putting on shoes. 2 Use low toilet seats and chairs without arms. 3 Place a chair inside the tub and remain seated while washing. 4 Keep the hip in a neutral, straight position when sitting or lying. 5 Inform the dentist about the prosthesis before any dental work.

3, 4, 5- Correct For a patient who had a hip fracture and has been treated by insertion of a prosthesis using a posterior approach, it is important to teach him or her and the caregiver about the measures to prevent dislocation. Certain measures, such as placing a chair in the tub and remaining seated while washing and keeping the hip in a neutral and straight position when sitting, lying, or walking prevents dislocation. The patient should be advised to inform his or her dentist about the prosthesis before any dental work, so that prophylactic antibiotics can be given if indicated. Many positions and daily activities predispose the patient to the dislocation of the prosthesis. Some of these activities include putting on one's own shoes and socks without using adaptive devices; crossing the legs or feet while seated; assuming the side-lying position incorrectly; standing up or sitting down while the body is flexed more than 90 degrees relative to the chair; and sitting on low seats, especially low toilet seats. It is also important to sit in chairs with arms, because these help the patient to rise to a standing position. Text Reference - p. 1527

A patient will undergo debridement of the shoulder joint. After the nurse explains the procedure, the patient asks the nurse what will be removed from the joint. How should the nurse answer? Select all that apply. 1 Synovial membrane 2 A wedge of bone 3 Joint debris 4 Degenerated menisci 5 Osteophytes

3, 4,5- Correct The procedure of debridement involves removing from a joint any devitalized tissue, such as loose bodies, joint debris, degenerated menisci, and osteophytes. This procedure is usually performed on the knee or the shoulder using a fiber optic arthroscope. Removal of synovial membrane is called synovectomy. The removal of a wedge of bone is called osteotomy. Text Reference - p. 1534

The nurse provides discharge instructions to a patient who has undergone total hip arthroplasty. Which statement by the patient indicates understanding of the instructions? 1. "I'll walk at least two miles a day after I get home." 2. "I may get back to work as soon as I feel that I'm able." 3. "I have to do the physical therapy exercises several times a day." 4. "I should take frequent bike rides to increase my activity and joint flexibility."

3- Correct

Which postoperative care, given by the nurse to the patient after a total hip replacement surgery, indicates an effective intervention? 1 Allowing the patient to sit on chairs without arms 2 Allowing the patient to cross legs at the knees or ankles 3 Allowing the patient to use a pillow between the legs for the first six weeks after surgery 4 Allowing the patient to perform daily activities such as putting on shoes and socks

3- Correct The nurse should allow the patient to use a pillow between the legs for the first six weeks after surgery. It should be used when lying on the nonoperative side or when in a supine position to maintain the joint in abduction and prevent dislocation of the new joint. Sitting on chairs without arms will lead to a sudden flexing of the body more than 90°, resulting in destabilization of the prosthesis. Crossing of the legs at the knees or ankles affects healing of the soft tissue of the hip joint, leading to predisposition of the joint. Performing daily activities such as putting on shoes and socks that require flexing the body more than 90°, will lead to damage of the soft tissue. Therefore, it should be avoided till at least six weeks after the surgery. Text Reference - p. 1526

The nurse suspects that a patient is experiencing a fat embolism after sustaining a femur fracture. What clinical manifestations does the nurse expect? 1 Tachypnea, tachycardia, shortness of breath, and paresthesia 2 Paresthesia, bradycardia, bradypnea, petechial rash on the chest and neck 3 Tachypnea, tachycardia, shortness of breath, petechial rash on the chest and neck 4 Bradypnea, bradycardia, shortness of breath, petechial rash on the chest and neck

3- Correct A fat embolism may occur in a patient who has had a fracture of a large bone such as a femur or hip. The classic symptoms of a fat embolism include tachypnea, tachycardia, shortness of breath, and petechial rash on the chest and neck. Tachypnea, tachycardia, shortness of breath, and paresthesias; paresthesias, bradycardia, bradypnea, and petechial rash; and bradypnea, bradycardia, shortness of breath, and petechial rash are not directly characteristic of a pulmonary embolism. Text Reference - p. 1523

A patient is hospitalized with severe bleeding in the leg. An x-ray of the leg reveals that the periosteum is intact across the fracture and that the bone is still in alignment. What type of fracture does the patient have? 1. Oblique fracture 2. Pathologic fracture 3. Greenstick fracture 4. Comminuted fracture

3- Correct A nondisplacement fracture in which the periosteum is intact across the fracture and the bone is still in alignment is classified as a greenstick fracture. In an oblique fracture, the line of the fracture extends in an oblique direction. A pathologic fracture is a spontaneous fracture at the site of a bone disease. Displaced fractures are usually comminuted fractures in which there are more than two bone fragments with the smaller fragments floating or oblique. Text Reference - p. 1512

The registered nurse is teaching the student nurse about an ideal candidate for shoulder replacement surgery. Which statement made by the student nurse indicates effective learning? 1 "A patient with acute pain and a history of osteoarthritis" 2 "A patient with acute pain and a history of rheumatoid arthritis" 3 "A patient with severe pain and a history of rheumatoid arthritis." 4 "A patient with humerus fracture and inadequate muscle strength"

3- Correct A patient who is suffering from severe pain with a history of rheumatoid arthritis is the best suitable candidate for shoulder replacement surgery. The presence of acute pain with a history of osteoarthritis can be managed through pharmacologic therapy. Similarly, a patient with acute pain and a history of rheumatoid arthritis is not considered for the surgery, because the disease can be managed through drugs. The presence of a humerus fracture and inadequate muscle strength indicate trauma, which would be treated with medication and physiotherapy rather than surgery. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 1535

Which joint is considered an ideal site for surgical fusions? 1 Hip joint 2 Knee joint 3 Wrist joint 4 Elbow joint

3- Correct Arthrodesis is the surgical fusion of a joint. Common areas of joint fusions are the wrist, ankle, and cervical spine. The hip, knee, and elbow joints are not considered ideal sites for surgical fusion, because fusion of those joints will lead to immobility. Text Reference - p. 1535

What action should a nurse should implement to prevent foot drop in a patient who has a full-leg cast? 1 Encourage bed rest 2 Maintain the foot in a boot with 45 degrees of flexion 3 Support the foot with 90 degrees of flexion 4 Place an antiembolic garment on the affected leg and foot.

3- Correct As a means of preventing foot drop in a leg with a cast, the foot should be supported with 90 degrees of flexion. Encouraging bed rest for his patient is not required. Supporting the foot with 45 degrees of flexion will not prevent foot drop. Antiembolic garments will protect against thromboembolic events but not foot drop. Text Reference - p. 1521

A patient with a leg fracture is scheduled for a fasciotomy. What complication is identified to have caused the need for this type of surgery? 1. Infection 2. Fat embolism syndrome 3. Compartment syndrome 4. Venous thromboembolism

3- Correct Compartment syndrome is characterized by swelling and increased pressure within a limited space, which presses and compromises the function of the blood vessels, nerves, and/or tendons that run through that compartment. Surgical decompression of soft tissue is done through fasciotomy. The occurrence of infection is greatly reduced with antibiotics in conjunction with aggressive surgical management. Fat embolism syndrome treatment includes fluid resuscitation to prevent hypovolemic shock, correction of acidosis, and replacement of blood loss. Venous thromboembolism can be managed with drug management therapy such as anticoagulants. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice questions. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 1522

A patient with a cast for a fractured radius reports, "My fingers feel numb." Which action is the highest priority for the nurse? 1 Elevating the arm on two pillows 2 Notifying the primary health care provider 3 Performing a thorough neurovascular assessment 4 Reassuring the patient that this is a normal response

3- Correct Numbness distal to a casted extremity is an indication of decreased circulation, nerve compression, and possibly compartment syndrome. The nurse should perform a full neurovascular assessment to determine the extent of the problem. After the nurse has performed the assessment, the arm may be elevated on two pillows while the primary health care provider is notified. Numbness in the fingers of the casted arm is not a normal response. Text Reference - p. 1518

Which postoperative care should be included in the nursing care plan of a patient who had surgery on the wrist? 1 Maintaining the strength in the affected extremity 2 Focusing on the patient's communication and adequate nutrition 3 An occupational therapist assisting the patient to perform hand exercises 4 Providing pain management techniques, including epidural or intrathecal analgesia

3- Correct The success of any surgery depends largely on the postoperative treatment plan, usually implemented by an occupational therapist. After wrist surgery, hand exercises would be suggested at least three or four times a day for 10 to 12 weeks under the guidance of an occupational therapist. Postoperative care that focuses on patient communication and adequate nutrition would be important for facial fractures. Passive and active exercises performed by the patient help to maintain the strength of the affected extremity; however, they are not specific to postoperative care. Pain management techniques include epidural or intrathecal analgesia. These are common interventions during any joint surgery. Text Reference - p. 1535

Which condition can be prevented with anticoagulant drugs in a patient who underwent orthopedic surgery? 1 Fat embolism 2 Bone infection 3 Thromboembolism 4 Compartment syndrome

3- Correct Thromboembolism can be prevented with anticoagulant drugs. These drugs diminish hypercoagulability. Antibiotics reduce bone infection. Corticosteroids treat fat embolism. Proper management techniques and surgery can relieve compartment syndrome. Text Reference - p. 1535

The nurse is providing discharge education to a patient with a fiberglass cast. What should the nurse be sure to include with the education? 1 It must not get wet 2 It has to be replaced every one to two weeks 3 The fiberglass is heavier than a plaster cast 4 Skin irritation is more common than with a plaster cast

4- Correct Although there are many advantages of fiberglass casts, such as its capacity to withstand wetness and its lightness compared to plaster, the one major disadvantage is that the particles of fiberglass may be irritating to the skin. A fiberglass cast is water-repellent and does not require replacement if it becomes wet. A fiberglass cast may remain on the patient for the duration of the treatment and does not require replacement every one to two weeks. A fiberglass cast is lighter than plaster. Text Reference - p. 1515

Which condition in a patient indicates that he or she is an ideal candidate for an osteotomy? 1 Synovitis 2 Osteoarthritis 3 Rheumatoid arthritis 4 Ankylosing spondylitis

4- Correct An osteotomy involves removing a wedge or slice of bone to change alignment and to shift weight bearing, correcting a deformity. A patient with ankylosing spondylitis may benefit the most from an osteotomy, because it corrects the deformity in the patient. Synovitis is the inflammation of the synovial membrane and is corrected through synovectomy. Osteoarthritis and rheumatoid arthritis are inflammatory disorders and are not treated with osteotomy. Text Reference - p. 1534

The nurse is assessing a patient who has a traumatic leg injury. What intervention is the most important in the initial assessment? 1 Assess the patient's pain level 2 Realign the extremity in the appropriate position 3 Check for full or partial loss of feeling and sensation 4 Determine the extremity's color and temperature in the area of the injury

4- Correct Baseline assessments are very important. It is most important to assess the extremity's color and temperature in the area of the injury to determine any venous or arterial insufficiency. If arterial or venous blood flow in the area is blocked, the area could become ischemic and die. Assessment of temperature is crucial to determine circulation and perfusion to the extremity and any change in temperature in the extremity should be reported promptly to the health care provider. Assessing the patient's pain is important but not as crucial as determining any arterial insufficiency. Realigning the injured extremity can lead to further damage or cause vascular insufficiency. Loss of sensation may be a late sign of neurovascular damage. Text Reference - p. 1518

A nurse evaluates a patient who reports twisting an ankle while walking down steps. Besides edema, which symptoms would most likely be observed if a nondisplaced simple fracture were present? 1. Numbness, coolness, and loss of pulse 2. Loss of sensation, redness, and warmth 3. Coolness, redness, and inability to bear weight 4. Redness, warmth, and inability to use the affected part

4- Correct Common signs of a fracture include edema, redness, warmth, inability to bear weight or use the affected joint, and pain at the site of injury. Coolness, tingling, numbness, and loss of pulses are signs of a vascular problem or may reflect a complication of a more complex fracture. Text Reference - p. 1512

A patient with a long leg cast reports pain in the toes. The nurse discovers that the toes are pale and cool to the touch with intact pulses and minimal neuropathy. The findings indicate that the patient may be experiencing: 1. A pressure ulcer 2. Osteomyelitis 3. A fat embolism 4. Compartment syndrome

4- Correct Compartment syndrome is the progressive compromise of neurovascular function of tissue in a confined space such as a cast. It may also result from circumferential inflammation around an extremity. The earliest sign is paresthesias, followed by pain, pressure resulting from edema, pallor, paralysis, and absence of pulse. (Absence of the peripheral pulse is a late and ominous sign.) A pressure ulcer is caused by decreased circulation due to pressure, tissue hypoxia, and destruction. Osteomyelitis is an infectious process within the bone. A fat embolism is an acute event in which fat globules released into circulation obstruct pulmonary circulation. It is seen with fractures of long bones such as the femur. Text Reference - p. 1522

This morning a patient had a long leg cast applied and wants to get up and try practice crutch walking. What is the best rationale that the nurse should give the patient for not allowing the patient to perform this task? 1 The cast is not dry yet and it may be damaged while using crutches. 2 The nurse does not have anyone available to accompany the patient. 3 Rest, ice, compression, and elevation (RICE) are in process to decrease pain. 4 Excess edema and other problems are prevented when the leg is elevated for 24 hours.

4- Correct For the first 24 hours after a lower extremity cast is applied, the leg will be elevated on pillows above the heart level to avoid excessive edema and compartment syndrome. The cast also will be drying during this 24-hour period, although it will not be damaged by use of crutches. The lack of having someone to accompany the patient is important for safety, but is not the most important reason. RICE is used for soft tissue injuries, not with long leg casts. Text Reference - p. 1516

The nurse is caring for a patient who underwent left total knee arthroplasty and has a new prescription to be "up in the chair today before noon." What action should the nurse take to protect the knee joint while carrying out the prescription? 1 Administer a dose of prescribed analgesic before completing the prescription. 2 Ask the physical therapist for a walker to limit weight bearing while getting out of bed. 3 Keep the continuous passive motion machine (CPM) in place while lifting the patient from bed to chair. 4 Put on a knee immobilizer before moving the patient in and out of bed and keep the surgical leg elevated while sitting.

4- Correct The nurse should apply a knee immobilizer for stability before assisting the patient to get out of bed. This is a standard measure to protect the knee during movement following surgery. Although an analgesic should be given before the patient gets up in the chair for the first time, it will not protect the knee joint. Full weight bearing is begun before discharge, so a walker will not be used if the patient did not need one before the surgery. The CPM machine is not kept in place while the patient is getting up to the chair. Text Reference - p. 1535

A patient status post right total knee arthroplasty has a prescription to get out of bed to the chair. Which action would the nurse take to protect the knee joint while carrying out the prescription? 1 Use a walker and two-person transfer technique. 2 Transfer the patient to the chair using a mechanical lift. 3 Ask the physical therapist to assist to limit weight bearing while the patient gets out of bed. 4 Ensure a knee immobilizer is in place and elevate the leg while sitting.

4- Correct The nurse should apply a knee immobilizer for stability before helping the patient out of bed. This is a standard measure to protect the knee during movement after surgery. A mechanical lift would not be necessary, because the patient can fully weight bear on the unaffected leg. A walker and assistance from the physical therapist may be considered, but the priority action would be to stabilize the knee and elevate it while sitting. Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer. Text Reference - p. 1535

The nurse is completing discharge teaching with a patient who has undergone total knee arthroplasty. Which statement would indicate the need for additional teaching? 1 "I should continue physical therapy as prescribed." 2 "I will increase intake of vitamins and minerals." 3 "I will report pain or swelling to the health care provider." 4 "I should expect that my knee may change shape."

4- Correct The patient should report a change in the shape of the knee, which could signal the onset of complications. Reporting pain or swelling, continuing physical therapy, and supplementing vitamins and minerals are all correct. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. Text Reference - p. 1535

The nurse is caring for a patient with a spinal bone fracture and osteoporosis. The patient asks the nurse for information on osteoporosis. The most appropriate response by the nurse is: 1 Tendons and ligaments become more flexible. 2 Almost 50% of a person's muscle mass is decreased by age 70. 3 An increase in motor neurons can lead to more problems with skeletal muscle movement. 4 For many people, diseases such as osteoarthritis and osteoporosis are not a normal part of growing older.

4- Correct These two bone diseases are not a normal part of aging for many people. In the aging adult, tendons and ligaments become less flexible, leading to more rigid movement. By age 70, a person's muscle mass is reduced by almost 30 percent. The number of motor neurons decrease, which leads to more physical problems. Text Reference - p. 1634