CH. 69 MUSCULOSKELETAL TRAUMA

23. According to the U.S. Department of Labor, occupation-related musculoskeletal disorders are illnesses or injuries of what? (Mark all that apply.) A) Nerves B) Cartilage C) Tendons D) Arteries E) Veins

A, B, C NERVES, CARTILAGE, TENDONS **According to the U.S. Department of Labor, occupation-related musculoskeletal disorders are injuries or illnesses of the muscles, nerves, tendons, joints, cartilage, and bones that occur because of exposure to work-related risks. Veins and arteries are not included in musculoskeletal disorders.

36. Your patient is returned from the PACU after an AKA of the right leg. You know to monitor for postoperative bleeding. Put your actions in the correct order that you would perform them if postoperative bleeding occurs after an amputation. A. Apply tourniquet that is kept at the bedside to affected limb. B. Monitor vital signs. C. Apply a pressure dressing. D. Call the surgeon.

A, B, C, D Apply tourniquet that is kept at the bedside to affected limb, Monitor vital signs, Apply a pressure dressing, Call the surgeon. **Immediate postoperative bleeding may develop slowly or may take the form of massive hemorrhage resulting from a loosened suture. A large tourniquet should be in plain sight at the patient's bedside, so that if severe bleeding occurs, it can be applied to the residual limb to control the hemorrhage. The nurse immediately notifies the surgeon in the event of excessive bleeding. A pressure dressing is only applied at the doctor's order.

4. The nurse is preparing the patient for discharge from the emergency room to home after incurring a sprain to the left ankle. While providing discharge teaching, the nurse is correct when they instruct the patient to what? A) Apply heat for the first 24 to 48 hours after injury B) Maintain the ankle in a dependent position C) Exercise hourly by performing rotation exercises of the ankle D) Apply an elastic compression bandage to the ankle

APPLY AND ELASTIC COMPRESSION BANDAGE TO THE ANKLE **Treatment of a sprain consists of resting and elevating the affected part, applying cold, and using a compression bandage. After the acute inflammatory stage (usually 24 to 48 hours after injury), heat may be applied intermittently.

31. A 77-year-old female has fallen in her home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the neck of the left femur. What complication is common in fractures of the neck of the femur? A) Osteoporosis B) Avascular necrosis C) Nonadherance of bones D) Septicemia

AVASCULAR NECROSIS **Fractures of the neck of the femur may damage the vascular system that supplies blood to the head and the neck of the femur, and the bone may become ischemic. For this reason, AVN is common in patients with femoral neck fractures. Osteoporosis is not a complication of a fractured femur neck. Options C and D are also not complications of a fractured femur neck.

22. The nursing instructor is discussing dislocations and subluxations with the beginning nursing students. Why would the instructor tell the students that dislocation and subluxations are medical emergencies and need to be reduced immediately? A) The longer the joint is misplaced, the harder it is to get it back in place B) Because the pain is so bad C) The longer the joint is misplaced, the more difficult it is to apply splints to immobilize the extremity D) Avascular necrosis may develop

AVASCULAR NECROSIS MAY DEVELOP **If a dislocation or subluxation is not reduced immediately, avascular necrosis (AVN) may develop.

25. A patient has presented to the emergency department with an injury to the wrist. The patient is diagnosed with a third-degree strain. Why would the physician order an x-ray of the wrist? A) Nerve damage is associated with third-degree strains. B) Compartment syndrome is associated with third-degree strains. C) Avulsion fractures are associated with third-degree strains. D) Greenstick fractures are associated with third-degree strains.

AVULSION FRACTURES ARE ASSOCIATED WITH THIRD DEGREE STRAINS **An x-ray should be obtained to rule out bone injury, because an avulsion fracture (in which a bone fragment is pulled away from the bone by a tendon) may be associated with a third-degree strain. Nerve damage, compartment syndrome, and greenstick fractures are not associated with third-degree strains.

39. An elderly woman with a fractured hip is being cared for on your unit. What are contributory factors in the incidence of falls and fractured hips? (Mark all that apply.) A) Living alone B) TIAs C) Emboli D) Decreased hearing E) General frailty

B, C, E TIA'S, EMBOLI, GENERAL FRAILTY **Elderly people (particularly women) who have low bone density from osteoporosis and who tend to fall frequently have a high incidence of hip fracture. Weak quadriceps muscles, general frailty due to age, and conditions that produce decreased cerebral arterial perfusion (transient ischemic attacks, anemia, emboli, cardiovascular disease, effects of medications) contribute to the incidence of falls. Decreased hearing and living alone do not contribute to the incidence of falls.

29. A 29-year-old male is admitted to the orthopedic unit with a fractured femur after running his motorcycle into a bridge abutment. The patient has been placed in traction until his femur can be rodded in surgery. What early complications would the nurse have to monitor this patient for? (Mark all that apply.) A) Alteration in elimination B) Alteration in personality C) Deep vein thrombosis D) Compartment syndrome E) Fat embolism

C, D, E DEEN VEIN THROMBOSIS, COMPARTMENT SYNDROME, FAT EMBOLISM **Early complications include shock, fat embolism, compartment syndrome, and venous thromboemboli (deep vein thrombosis [DVT], pulmonary embolism [PE]). Alteration in elimination and Alteration in personality are nursing diagnosis, not complications.

32. A 74-year-old male has fallen and broken his hip. What must the nurse be sure to assess the patient for so that complications can be prevented? A) Family history B) AVN C) Chronic conditions D) Fat embolism

CHRONIC CONDITIONS **To prevent complications, the nurse must assess the elderly patient for chronic conditions that require close monitoring. Family history is assessed but it does not prevent complications. A fat embolism is an early complication; assessing for it does not prevent complications. An AVN is the result of certain types of hip fractures; assessing for it does not aid in preventing fractures.

10. Six weeks after an above the knee (AKA) amputation, a patient returns to the outpatient office for a routine postoperative check up. During the nurse's assessment, the patient reports symptoms of phantom pain. What would the nurse correctly tell the patient to do to reduce the discomfort of the phantom pain? A) Apply hot compresses to the area of the amputation. B) Avoid rehabilitation exercises until the pain subsides. C) Comfortably increase their level of activity. D) Assess for a pulse in the extremity of the amputation every 4 to 6 hours

COMFORTABLY INCREASE THEIR LEVEL OF ACTIVITY **Keeping the patient active helps decrease the occurrence of phantom pain. Early intensive rehabilitation and stump desensitization with kneading massage brings relief. Hot compresses should be avoided, as the extreme heat can compromise the tissue integrity of the area of healing. It is not necessary for the patient to assess a pulse in the affected extremity every 4 to 6 hours if experiencing phantom pain, as the cause of the pain is unknown.

1. A patient is arriving to the orthopedic floor from the emergency room. While giving report to the floor nurse, the emergency room nurse states that the patient has a fracture of the nose that has resulted in a skin tear and involvement of the mucous membranes of the nasal passages. The orthopedic nurse is aware that this description likely indicates which type of fracture? A) Compression B) Compound C) Impacted D) Transverse

COMPOUND **A compound fracture involves damage to the skin or mucous membranes and is also called an open fracture. A compression fracture involves compression of bone and is seen in vertebral fractures. An impacted fracture occurs when a bone fragment is driven into another bone fragment. A transverse fracture occurs straight across the bone shaft.

15. A 16-year-old girl is taken to the emergency department after being kicked in the lower leg during a volleyball match. The leg area has become swollen and discolored. The triage nurse recognizes that the patient has likely sustained what? A) Sprain B) Strain C) Contusion D) Dislocation

CONTUSION **A contusion is a soft-tissue injury that results in bleeding into soft tissues, creating a hematoma and ecchymosis. A sprain is an injury to ligaments caused by wrenching or twisting. A strain is a "muscle-pull" from overuse, overstretching, or excessive stress. A dislocation is a condition in which the articular surfaces of the bones forming a joint are no longer in anatomic contact.

20. A patient with a fractured left femur is being cared for by an orthopedic nurse. The nurse would know that what signs indicate potential fat emboli? A) Increased partial pressure of arterial oxygen (PaO2), reduced sensation in left leg or foot B) Left leg pain, dyspnea C) Bradycardia, skin bruises D) Cyanosis, decreased PaO2

CYANOSIS, DECREASED PaO2 **Fat emboli may occur with fractures of the long bones and pelvis and may be fatal. Clinical manifestations include cyanosis, dyspnea, tachycardia, chest pain, tachypnea, apprehension, restlessness, confusion, petechiae, and decreased PaO2. Increased PaO2 reduced sensation in left leg or foot, pain in the affected extremity, skin bruises, and bradycardia aren't associated with fat emboli.

24. A hockey player is brought to the emergency department after a game because of an injury. He is complaining of not being able to move his left arm, and his left arm appears longer than his right arm. The triage nurse suspects the hockey player has what? A) Dislocated left shoulder B) Fractured left clavicle C) Dislocated left elbow D) Fractured left humerus

DISLOCATED LEFT SHOULDER **Symptoms of a dislocated shoulder: pain. lack of motion, may feel empty shoulder socket, uneven posture in comparison to other shoulder, affected arm appears longer, abduction limited.

12. You are caring for a patient wearing a sling to support her arm after a clavicle fracture. What would the nurse instructs the patient to do? A) Elevate the arm above the shoulder 3 or 4 times daily. B) Avoid moving the elbow, wrist, and fingers for about 2 months. C) Engage in active range of motion using the affected bone. D) Use the arm for light activities within the range of motion.

ELEVATE THE ARM ABOVE THE SHOULDER 3 OR 4 TIMES DAILY **A patient with a clavicle fracture may use a sling to support the arm and relieve the pain. The patient may be permitted to use the arm for light activities within the range of comfort. The patient should not elevate the arm above the shoulder level until the ends of the bones have united at about 6 weeks, but the nurse should encourage the patient to exercise the elbow, wrist, and fingers. Vigorous activity is limited for 3 months.

11. The nurse is caring for a patient who had a right extremity below the knee amputation (BKA). The nurse recognizes the importance of implementing measures that focus on preventing flexion contracture of the hip and maintaining proper positioning. Which of the following measures will achieve these goals? A) Encouraging the patient to turn from side to side and to assume a prone position B) Initiating ROM exercises of the hip and knee 3 months after the amputation C) Minimizing movement of the flexor muscles of the hip D) Encouraging the patient to sit in the chair for at least 8 hours of the day

ENCOURAGING THE PATIENT TO TURN FROM SIDE TO SIDE AND TO ASSUME A PRONE POSITION **The nurse encourages the patient to turn from side to side and to assume a prone position, if possible, to stretch the flexor muscles and to prevent flexion contracture of the hip. Postoperative ROM exercises are started early, because contracture deformities develop rapidly. ROM exercises include hip and knee exericises for patients with BKAs. The nurse also discourages sitting for prolonged periods of time.

9. A patient with a simple fracture is involved in discharge teaching with their nurse. What would the nurse instruct the patient to do? A) Elevate the affected extremity to shoulder level. B) Engage in exercises that strengthen the unaffected muscles. C) Take corticosteroids as prescribed. D) Expect to regain full strength and mobility in 2 to 4 weeks.

ENGAGE IN EXERCISES THAT STRENGTHEN THE UNAFFECTED MUSCLES **The nurse will encourage the patient to engage in exercises that strengthen the unaffected muscles. Corticosteroids should be avoided, as this classification of drug will inhibit the healing of the fracture. The nurse should inform the patient that fracture healing and restoration of full strength may take months. Comfort measures may include analgesics and elevation of the affected extremity to the heart level.

18. A 28-year-old man with a fractured humerus calls the nurse into his room. Upon assessment, the nurse finds the patient to be tachycardic, pale, and confused. The nurse suspects the patient may be experiencing which of the following complications? A) Disseminated intravascular coagulopathy B) Compartment syndrome C) Fat emboli D) Deep vein thrombosis

FAT EMBOLI **Long-bone fractures may develop fat emboli syndrome, which presents with features including hypoxia, tachypnea, tachycardia, pyrexia, and mental status changes.

17. The nurse is performing a shift assessment on an elderly patient who is recovering after surgery for a hip fracture. The nurse notes that the patient is complaining of chest pain, has an increased heart rate and respiratory rate. The nurse further notes that the patient is febrile and hypoxic, coughing and producing large amounts of thick white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, as she recognizes that this patient is likely demonstrating symptoms related to what? A) Avascular necrosis of bone B) Compartment syndrome C) Fat embolism syndrome D) Complex regional pain syndrome

FAT EMBOLISM SYNDROME **Fat embolism syndrome occurs most frequently in young adults and elderly patients who experience fractures of the proximal femur (ie, hip fracture). Presenting features of fat embolism syndrome include hypoxia, tachypnea, tachycardia, and pyrexia. The respiratory distress response includes tachypnea, dyspnea, wheezes, precordial chest pain, cough, large amounts of thick white sputum, and tachycardia. Avascular necrosis (AVN) occurs when the bone loses its blood supply and dies it does not include coughing and neither does complex regional pain syndrome.

26. A 12-year-old boy is brought in by ambulance to the emergency department after being involved in an accident while participating in a BMX race. The boy has an open fracture of his tibia. The wound is highly contaminated and there is extensive soft tissue damage. What grade fracture would this be considered? A) Grade I B) Grade II C) Grade III D) Grade IV

GRADE IV **Open fractures are graded according to the following criteria. Grade I is a clean wound less than 1 cm long. Grade II is a larger wound without extensive soft tissue damage. Grade III is highly contaminated, has extensive soft tissue damage, and is the most severe. There is no grade IV fracture.

16. Radiographs were ordered for a 10-year-old boy who had his right upper arm injured. The radiographs show that the humerus appears to be fractured on one side and slightly bent on the other. What type of fracture is this an example of? A) Impacted B) Compound C) Compression D) Greenstick

GREENSTICK **Greenstick fractures are a result of the bone being broken on one side, while the other side is bent. Therefore options A, B, and C are incorrect.

33. Patients who have had amputations are cared for by a multidisciplinary rehabilitation team. What does the multidisciplinary team do for patients who are amputees? A) Ensure top quality health care B) Provide holistic health care C) Assist in preventing complications D) Help achieve the highest possible level of function

HELP ACHIEVE THE HIGHEST LEVEL OF FUNCTION **The multidisciplinary rehabilitation team (patient, nurse, physician, social worker, physical therapist, occupational therapist, psychologist, prosthetist, vocational rehabilitation worker) helps the patient achieve the highest possible level of function and participation in life activities. Prosthetic clinics and amputee support groups facilitate this rehabilitation process.

13. The orthopedic nurse is precepting a graduate nurse. They are caring for four fracture patients. The orthopedic nurse asks the graduate nurse which of their patients is at an increased risk for Volkmann's contracture. What should the graduate nurse respond? A) Femur B) Humerus C) Radial head D) Clavicle

HUMERUS **The most serious complication of a supracondular fracture of the humerus is Volkmann's ischemic contracture, which results from antecubital swelling or damage to the brachial artery.

6. While caring for a patient with a hip fracture, the nurse will instruct the patient to do what to prevent the most common complication associated with a hip fracture? A) Take the prescribed stool softener daily. B) Use the prescribed oxygen with ambulation. C) Increase fluid intake. D) Avoid movement of the feet and ankles

INCREASE FLUID INTAKE **Deep vein thrombosis (DVT) is the most common complication related to a hip fracture. To prevent DVT, the nurse encourages intake of fluids and ankle and foot exercises. While respiratory complications commonly include atelectasis and pneumonia, the use of deep-breathing exercises, changes in position at least every 2 hours, and the use of incentive spirometry help prevent the respiratory complications. Constipation may also occur after a hip fracture, but is not the most common complication.

7. A clinic nurse is caring for a patient who has a tibial fracture. The patient has just had a long-leg walking cast removed and a short leg cast applied. The nurse explains to the patient that the short leg cast will allow for what? A) Ankle motion B) Knee motion C) Hip motion D) Toe motion

KNEE MOTION **A short leg cast or brace is placed 3 to 4 weeks after the fracture and will allow for knee motion that is not allowed by the long leg walking cast.

30. The patient is 6 weeks post-ORIF of his ankle when he comes to the orthopedic clinic for a follow-up appointment. The physician informs the patient that the bones in his ankle have not grown back together. What type of complication is this considered? A) Late complication B) Early complication C) Minor complication D) Major complication

LATE COMPLICATION **Late complications include delayed union, malunion, and nonunion; therefore options B, C, and D are incorrect.

14. The nurse at the pediatrian's office is assessing a 17-year-old soccer player who presented to the clinic stating that he sustained an injury that resulted in the knee being struck medially while his foot is firmly planted on the ground. The nurse knows that the patient likely has experienced what? A) Lateral collateral ligament injury B) Medial collateral ligament injury C) Anterior cruciate ligament injury D) Posterior cruciate ligament injury

LATERAL COLLATERAL LIGAMENT INJURY **When the knee is struck medially, damage may occur to the lateral collateral ligament. If the knee is struck laterally, damage may occur to the medial collateral ligament.

37. A patient is a BKA amputee who is to be discharged in 48 hours. You are going over discharge teaching with this patient. You review what factors with this patient? A) Exercise B) Nutrition C) Support groups D) Mobility aids

MOBILITY AIDS **The patient receives ongoing instructions and practice sessions to learn to transfer and to use mobility aids and other assistive devices safely.

2. A patient has sustained a long bone fracture. The nurse is preparing a care plan for this patient. Which intervention should the nurse include in the care plan to enhance fracture healing? A) Limit weight-bearing and exercising B) Monitor color, temperature, and pulses of the affected extremity C) Avoid immobilization of the fracture fragments D) Administration of high doses of corticosteroids

MONITOR COLOR, TEMPERATURE, AND PULSESOF THE AFFECTED EXTREMITY **A second-degree strain involves tearing of muscle fibers and is manifested by notable loss of load-bearing strength with accompanying edema, tenderness, muscle spasm, and ecchymosis. A first-degree strain reflects tearing of a few muscle fibers and is accompanied by minor edema, tenderness, and mild muscle spasm, without noticeable loss of function. A first-degree sprain is caused by tearing of a few ligamentous fibers and is manifested by mild edema, local tenderness, and pain that is elicited when the joint is moved, but there is no joint instability. A second-degree sprain involves tearing of nerve fibers and results in increased edema, tenderness, pain with motion, joint instability, and partial loss of normal joint function.

38. As an amputee a patient is being assessed prior to being discharged home. What is an expected patient outcome the nurse would assess for? A) Patient exhibits healed, nontender, nonadherent scar B) Patient can stand for at least 2 hours C) Patient eats three nutritious meals daily D) Patient exercises 30 minutes weekly

PATIENT EXHIBITS HEALED, NONTENDER, NONADHERENT SCAR ** Expected patient outcomes may include the following: achieves wound healing; controls residual limb edema; exhibits healed, nontender, nonadherent scar; demonstrates residual limb care.

19. iWhich of the following is the most appropriate nursing intervention for the nursing diagnosis of Impaired physical mobility related to fractured hip? A) Administer analgesics as required. B) Place pillow between legs when turning. C) Monitor vital signs. D) Assess wound appearance.

PLACE PILLOW BETWEEN LEGS WHEN TURNING **Placing a pillow between the patient's legs when turning prevents adduction and supports the patient's legs. Administering analgesics is appropriate for the nursing diagnosis of pain. Monitoring vital signs is appropriate for the nursing diagnoses related to hyperthermia, ineffective breathing pattern or impaired cardiac output. Assessing wound appearance would be appropriate for a nursing diagnosis of Impaired skin integrity.

35. You are caring for a patient who has had an amputation. What nursing action would you be least likely to perform with this type of patient? A) Teaching the patient self-care activities B) Placing the residual limb on a pillow C) Promoting mobility D) Teaching the patient how to wrap the stump

PLACING THE RESIDUAL LIMB ON A PILLOW **The residual limb should not be placed on a pillow, because a flexion contracture of the hip may result. This would be the least likely nursing action you would perform.

34. A rehabilitation nurse is working with a patient who is an amputee. The nurse knows that it is important for a patient who is an amputee to be an active participant is self-care. What do the nurse and patient need to maintain during the learning process? A) Positive attitudes B) Balanced nutrition C) Optimal mobility D) Family support

POSITIVE ATTITUDES **Amputation of an extremity affects the patient's ability to provide adequate self-care. The patient is encouraged to be an active participant in self-care. The patient needs time to accomplish these tasks and must not be rushed. Practicing an activity with consistent, supportive supervision in a relaxed environment enables the patient to learn self-care skills. The patient and the nurse need to maintain positive attitudes and to minimize fatigue and frustration during the learning process. Balanced nutrition, optimal mobility, and family support are important in the rehabilitation process but they do not have a higher priority in the delivery of care to amputees than the maintaining of positive attitudes.

27. A 25-year-old male is involved in a motorcycle accident and injures his arm. The physician diagnoses the man with an intra-articular fracture and splints the injury. When the man comes back for his 6-week checkup the nurse implements the teaching plan she has developed for this patient. What sequelae of intra-articular fractures would the nurse be sure to inform the patient about? A) Post-traumatic arthritis B) Post-traumatic nerve damage C) Post-traumatic stress syndrome D) Post-traumatic compartment syndrome

POST-TRAUMATIC ARTHRITIS **Intra-articular fractures often lead to post-traumatic arthritis. Research does not indicate a correlation between intra-articular fractures and nerve damage, PTSD, or compartment syndrome.

40. The patient was placed in a long arm cast after fracturing her humerus. Twelve hours after the application of the cast, the patient tells the nurse that her arm hurts. Analgesics do not relieve the pain. What would be the most appropriate nursing action? A) Preparing the patient for cast removal or bivalving of the cast B) Obtaining an order for a different pain medication C) Encouraging the patient to wiggle and move the fingers D) Petaling the edges of his cast

PREPARING THE PATIENT FOR CAST REMOVAL OR BIVALVING OF THE CAST **Acute compartment syndrome involves a sudden and severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur. The patient complains of deep, throbbing, unrelenting pain, which continues to increase despite the administration of opioids and seems out of proportion to the injury. Removing or bivalving the cast relieves pressure. Ordering different analgesics doesn't address the underlying problem. Encouraging the patient to move the fingers or perform range-of-motion exercises won't treat or prevent compartment syndrome. Petaling the edges of a cast with tape prevents abrasions and skin breakdown, not compartment syndrome.

5. The nurse is writing a care plan for a patient admitted to the Emergency Department (ED) with an open fracture. The nurse will assign priority to what nursing diagnosis for a patient with an open fracture of the radius? A) Risk for infection B) Risk for activity intolerance C) Risk for imbalanced nutrition: less than body requirements D) Risk for powerlessness

RISK FOR INFECTION **While all nursing diagnoses may be pertinent to the care of a patient with an open fracture of the radius, the nursing diagnosis that will receive the highest priority is "Risk for infection" related to the risks of osteomyelitis and tetanus. The objectives of management are to prevent infection of the wound, soft tissue, and bone and to promote healing. Another priority diagnosis for a patient with an open fracture would be "Risk for peripheral neurovascular dysfunction".

28. A 65-year-old female patient has fallen and injured her ankle. Radiographs show that the woman has a trimalleolar fracture. The physician informs the woman that she needs surgery to repair her ankle. What type of internal fixation device would be used to hold the malleolus of the tibia in place? A) Plate B) Wire C) Screw D) Rod

SCREW **Through a surgical approach, the fracture fragments are anatomically aligned. Internal fixation devices (metallic pins, wires, screws, plates, nails, or rods) may be used to hold the bone fragments in position until solid bone healing occurs. Screws are used to hold the small malleolus in anatomical place after it has broken off the tibia.

3. The nurse is assessing a patient's right knee. The assessment shows edema, tenderness, muscle spasms, and ecchymosis. The patient states that 2 days ago he ran 10 miles and now it hurts to stand up. Based upon these symptoms, the nurse bases her teaching upon the fact that she anticipates the patient has experienced what? A) A first-degree strain B) A second-degree strain C) A first-degree sprain D) A second-degree sprain

SECOND DEGREE STRAIN **A second-degree strain involves tearing of muscle fibers and is manifested by notable loss of load-bearing strength with accompanying edema, tenderness, muscle spasm, and ecchymosis. A first-degree strain reflects tearing of a few muscle fibers and is accompanied by minor edema, tenderness, and mild muscle spasm, without noticeable loss of function. A first-degree sprain is caused by tearing of a few ligamentous fibers and is manifested by mild edema, local tenderness, and pain that is elicited when the joint is moved, but there is no joint instability. A second-degree sprain involves tearing of nerve fibers and results in increased edema, tenderness, pain with motion, joint instability, and partial loss of normal joint function.

21. A 55-year-old male is brought to the emergency department by ambulance after stepping in a hole and falling. While assessing him the nurse notes that his right leg is shorter than his left leg; his right hip is deformed and he is in acute pain. What would the nurse suspect has happened to this patient? A) Subluxated right hip B) Fractured right hip C) Right pelvic fracture D) Traumatic dislocation of right hip

TRAUMATIC DISLOCATION OF RIGHT HIP **Signs and symptoms of a traumatic dislocation include acute pain, change in positioning of the joint, shortening of the extremity, deformity, and decreased mobility. A subluxation is a partial dislocation and does not cause as much deformity as a complete dislocation. A fracture does not necessarily cause a deformity. A pelvic fracture would not cause a deformity of the right hip.

8. The patient scheduled for a Syme amputation in the morning is concerned about the ability to stand on the amputated extremity. The patient asks the nurse about his ability to stand after surgery. What is the nurse's best response to this question? A) "You will be able to withstand full weight-bearing on this durable extremity after the amputation." B) "You will have minimal weight-bearing on this extremity and will require the use of an assistive device." C) "You will not be able to use this extremity and will receive teaching on use of a wheelchair." D) "You will be fitted for a prosthesis and your commitment to rehabilitation will determine your functional abilities."

YOU WILL BE ABLE TO WITHSTAND FULL WEIGHT-BEADING ON THIS DURABLE EXTREMITY AFTER THE AMPUTATION **Syme amputation (modified ankle disarticulation amputation) is performed most frequently for extensive foot trauma and produces a painless, durable extremity end that can withstand full weight-bearing. Therefore options B, C, and D are incorrect.