Chapter 40: Musculoskeletal Care Modalities
The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? "The traction can be removed once a day so I can shower." "I will wear a boot with weights attached." "Metal pins will go through my skin to the bone." "A belt will go around my pelvis and weights will be attached."
"Metal pins will go through my skin to the bone."
An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? -72 hours -24 hours -2 to 3 weeks 1 week
24 hours
A client has a fiberglass cast on the right arm. Which action should the nurse include in the care plan?
Assessing movement and sensation in the fingers of the right hand
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 -Keeping the client from sliding to the foot of the bed -Keeping the ropes over the center of the pulley -Ensuring that the weights hang free at all times
Assessing the extremity for neurovascular integrity
Which action would be most important postoperatively for a client who has had a knee or hip replacement? -Encouraging expressions of anxiety. -Assisting in early ambulation. -Providing crutches to the client. -Using a continuous passive motion (CPM) machine.
Assisting in early ambulation.
Which would be contraindicated as a component of self-care activities for the client with a cast? -Cover the cast with plastic to insulate it -Elevate the casted extremity to heart level frequently -Do not attempt to scratch the skin under a cast -Cushioning rough edges of the cast with tape
Cover the cast with plastic to insulate it
Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure? -Arthrodesis -Fasciotomy -Arthroplasty -Osteotomy
Fasciotomy
Which type of cast encloses the trunk and a lower extremity? -Short-leg -Hip spica -Body cast -Long-leg
Hip spica
Which action by the nurse would be inappropriate for the client following casting? -Handle the cast with the palms of hands. -Protect the cast by covering with a sheet. -Petal and smooth the edges of the cast. -Circulate room air with a portable fan.
Protect the cast by covering with a sheet.
A nurse is given instructions to a client who's going home with a leg cast. Which teaching point is most critical? -Avoiding walking on a leg cast without the health care provider's permission -Exercising joints above and below the cast, as ordered -Using crutches properly -Reporting signs of impaired circulation
Reporting signs of impaired circulation
The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is: -Risk for ineffective therapeutic regimen management -Risk for avascular necrosis of the joint -Situational low self-esteem -Disturbed body image
Risk for ineffective therapeutic regimen management
Which device is designed specifically to support and immobilize a body part in a desired position? -Continuous passive motion (CPM) device -Brace -Splint -Trapeze
Splint
The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? -Pulleys without evidence of the obstruction -Body aligned opposite to line of traction pull -Ropes freely moving over pulleys -Weights hanging and touching the floor
Weights hanging and touching the floor
A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period? -hematoma -hemorrhage -infection -osteomyelitis
osteomyelitis
A client is about to have a cast applied to the left arm. What will nurse alert the client to as the cast is applied? -Sensation of weakness -Increase in pain in the left arm -Arm being moved to various positions -Sensations of warmth or heat with application
Sensations of warmth or heat with application
A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? -Elevate the affected extremity and use cold applications. -Breathe deeply and cough every 2 hours until ambulation is possible. -Do ROM exercises as indicated -Apply anti-embolism stockings as indicated
Elevate the affected extremity and use cold applications.
What is an inappropriate use of traction? a) Decrease space between opposing structures b) Reduce deformity c) Minimize muscle spasms d) Immobilize a fracture
a) Decrease space between opposing structures **Traction is done to increase the space between opposing surfaces. Traction is used to minimize muscle spasms, to reduce, align, and immobilize fractures and to reduce deformity.
The nurse is helping to set up Buck's traction on an orthopedic patient. How often should the nurse assess circulation to the affected leg? A) Within 30 minutes, then every 1 to 2 hours B) Within 30 minutes, then every 4 hours C) Within 30 minutes, then every 8 hours D) Within 30 minutes, then every shift
Ans: A Feedback: After skin traction is applied, the nurse assesses circulation of the foot or hand within 15 to 30 minutes and then every 1 to 2 hours.
Which device is designed specifically to support and immobilize a body part in a desired position? a) Continuous passive motion (CPM) device b) Trapeze c) Splint d) Brace
c) Splint A splint may be applied to a fractured extremity initially until swelling subsides.
Meniscectomy refers to the a) removal of a body part b) incision and diversion of the muscle fascia c) replacement of one of the articular surfaces of a joint d) excision of damaged joint fibrocartilage
d) excision of damaged joint fibrocartilage. The m/c site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage.
The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication? -Dislocation of the hip -Contracture of the hip -Re-fracture of the hip -Avascular necrosis of the hip
-Dislocation of the hip
A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. the nurse identifies this as which type of cast? -Gauntlet Cast -Spica Cast -Short Arm Cast -Body Cast
Gauntlet Cast
To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan? -Reduce fluid intake. -Remove the weights during linen changes. -Increase fiber intake. -Increase calorie intake.
Increase fiber intake.
A patient with a fractured femur is in balanced suspension traction. The patient needs to be repositioned toward the head of the bed. During repositioning, what should the nurse do? A) Place slight additional tension on the traction cords. B) Release the weights and replace them immediately after positioning. C) Reposition the bed instead of repositioning the patient. D) Maintain consistent traction tension while repositioning.
Ans: D Feedback: Traction is used to reduce the fracture and must be maintained at all times, including during repositioning. It would be inappropriate to add tension or release the weights. Moving the bed instead of the patient is not feasible.
A patient is scheduled for a total hip replacement and the surgeon has explained the risks of blood loss associated with orthopedic surgery. The risk of blood loss is the indication for which of the following actions? A) Use of a cardiopulmonary bypass machine B) Postoperative blood salvage C) Prophylactic blood transfusion D) Autologous blood donation
Ans: D Feedback: Many patients donate their own blood during the weeks preceding their surgery. Autologous blood donations are cost effective and eliminate many of the risks of transfusion therapy. Orthopedic surgery does not necessitate cardiopulmonary bypass and blood is not salvaged postoperatively. Transfusions are not given prophylactically.
A nurse is caring for a patient who is in skeletal traction. To prevent the complication of skin breakdown in a patient with skeletal traction, what action should be included in the plan of care? A) Apply occlusive dressings to the pin sites. B) Encourage the patient to push up with the elbows when repositioning. C) Encourage the patient to perform isometric exercises once a shift. D) Assess the pin insertion site every 8 hours.
Ans: D Feedback: The pin insertion site should be assessed every 8 hours for inflammation and infection. Loose cover dressings should be applied to pin sites. The patient should be encouraged to use the overhead trapeze to shift weight for repositioning. Isometric exercises should be done 10 times an hour while awake.
A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first? -"My toes are stiff" -"My cast is still wet -"My pain is 3" -My toes are pink"
"My toes are stiff"
Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) "Place pillows between your legs when you lay on your side." "Avoid bending forward when sitting in a chair." "You may cross your legs at the ankles only." "Use a raised toilet seat and high-seated chair." "It is okay to briefly flex the hip to put on your clothes."
"Place pillows between your legs when you lay on your side." "Avoid bending forward when sitting in a chair." "Use a raised toilet seat and high-seated chair."
The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? -Heart rate of 94 beats/minute -Client complains of pain in the affected rib area when taking a deep breath -Blood pressure of 140/90 mm Hg -Crackles in the lung bases
-Crackles in the lung bases
A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client? -Cutting of a bivalve cast -Cutting a cast window -Insertion of an external fixator -Removal of the cast
-Cutting a cast window
The nurse is caring for a client with a spica cast. What is the nurse's priority intervention? -Keep the cast clean and dry. -Promote elimination with a regular bedpan. -Position the client on the affected side. -Keep the legs in abduction.
-Keep the cast clean and dry.
A patient arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the patient to describe the pain? -Similar to "muscle cramps" -Sharp and piercing -Sore and aching -A dull, deep, boring ache
-Sharp and piercing
A patient had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated? -Diminished peripheral pulses on the affected extremity -The patient has discomfort when moving in the bed. -The left leg is internally rotated. -The leg length is the same as the right leg.
-The left leg is internally rotated.
A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation? -Internal rotation -Adduction -Abduction -Flexion
Abduction
A patient has a cast removed after bone healing takes place. What should the nurse instruct the patient to do after removal? (Select all that apply.) -Control swelling with elastic bandages, as directed. -Use friction to remove dead surface skin by rubbing the area with a towel. -Apply an emollient lotion to soften the skin. -Use a razor to shave the dead skin off. -Gradually resume activities and exercise.
Control swelling with elastic bandages, as directed. Apply an emollient lotion to soften the skin. Gradually resume activities and exercise.
A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate? -Administer antianxiety and pain medication. -Call for assistance to hold the client in the required position until the cast has dried. -Remove the cast immediately, notifying the physician. -Explain that the sensation being felt is normal and will not burn the client.
Explain that the sensation being felt is normal and will not burn the client.
A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan? -Fingers on the left hand are swollen and cool -Presence of a normal popliteal pulse -Minimal pain in the left arm -Cast edges are rough, with skin irritation present
Fingers on the left hand are swollen and cool
The nurse is very concerned about the potential debilitating complication of peroneal nerve injury. What symptom does the nurse recognize as a result of that complication? -Deep vein thrombosis (DVT) -Permanent paresthesias -Footdrop -Infection
Footdrop
The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Fahrenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. the nurse interprets these findings as indicating which complication? -Osteomyelitis -Hypovolemic Shock -Atelectasis -Urinary Retention
Hypovolemic Shock
Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? -Open reduction -Total joint arthroplasty -Arthrodesis -Joint arthroplasty
Open reduction
A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize? -Right shoulder slopes downward and droops inward -Client complains of tingling and numbness in the right shoulder. -Client complains of pain in the unaffected shoulder. -Right shoulder is elevated above the left.
Right shoulder slopes downward and droops inward
Which is not a guideline for avoiding hip location after replacement surgery. -Put a pillow between the legs when sleeping. -The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes, -Never cross the legs when seated. -Keep the knees apart at all times.
The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes,
A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? -Osteotomy -Hemiarthroplasty -Arthrodesis -Total arthroplasty
Total arthroplasty
What would be an inappropriate initial pain relief measure for the client with a cast? a) Application of a new cast b) Administration of analgesics c) Elevation of the involved part d) Application of cold packs
a) Application of a new cast Most pain can be relieved by elevating the casted part of the body, and by applying cold packs as prescribed and administering analgesics.
Which nursing action would help prevent DVT in a client who has had an orthopedic surgery? a) Apply anti-embolism stockings b) Instruct about exercise, as prescribed c) Instruct about using client-controlled analgesia, if prescribed d) Apply cold packs
a) Apply anti-embolism stockings
A hip spica cast: -is a short or long leg cast reinforced for strength. -encloses the trunk and a lower extremity. -encircles the trunk. -extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.
encloses the trunk and a lower extremity.
A patient has had a brace prescribed to facilitate recovery from a knee injury. What are the potential therapeutic benefits of a brace? Select all that apply. A) Preventing additional injury B) Immobilizing prior to surgery C) Providing support D) Controlling movement E) Promoting bone remodeling
Ans: A, C, D Feedback: Braces (i.e., orthoses) are used to provide support, control movement, and prevent additional injury. They are not used to immobilize body parts or to facilitate bone remodeling.
A patient is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The patient is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement? A) "Actually, patients are only on bed rest for 2 to 3 days before they begin walking with assistance." B) "The physical therapist will likely help you get up using a walker the day after your surgery." C) "Our goal will actually be to have you walking normally within 5 days of your surgery." D) "For the first two weeks after the surgery, you can use a wheelchair to meet your mobility needs."
Ans: B Feedback: Patients post-THA begin ambulation with the assistance of a walker or crutches within a day after surgery. Wheelchairs are not normally utilized. Baseline levels of mobility are not normally achieved until several weeks after surgery, however.
A patient is complaining of pain in her casted leg. The nurse has administered analgesics and elevated the limb. Thirty minutes after administering the analgesics, the patient states the pain is unrelieved. The nurse should identify the warning signs of what complication? A) Subcutaneous emphysema B) Skin breakdown C) Compartment syndrome D) Disuse syndrome
Ans: C Feedback: Compartment syndrome may manifest as unrelenting, uncontrollable pain. This presentation of pain is not suggestive of disuse syndrome or skin breakdown. Subcutaneous emphysema is not a complication of casting.
A 91-year-old patient is slated for orthopedic surgery and the nurse is integrated gerontologic considerations into the patient's plan of care. What intervention is most justified in the care of this patient? A) Administration of prophylactic antibiotics B) Total parenteral nutrition (TPN) C) Use of a pressure-relieving mattress D) Use of a Foley catheter until discharge
Ans: C Feedback: Older adults have a heightened risk of skin breakdown; use of a pressure-reducing mattress addresses this risk. Older adults do not necessarily need TPN and the Foley catheter should be discontinued as soon as possible to prevent urinary tract infections. Prophylactic antibiotics are not a standard infection prevention measure.
Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? a) Joint arthroplasty b) Open reduction c) Total join arthroplasty d) Arthrodesis
b) Open reduction
A physician writes an order to discontinue skeletal traction on an orthopedic patient. The nurse should anticipate what subsequent intervention? A) Application of a walking boot B) Application of a cast C) Education on how to use crutches D) Passive range of motion exercises
Ans: B Feedback: After skeletal traction is discontinued, internal fixation, casts, or splints are then used to immobilize and support the healing bone. The use of a walking boot, crutches, or ROM exercises could easily damage delicate, remodeled bone.
Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure? a) Fasciotomy b) Arthroplasty c) Arthrodesis d) Osteotomy
a) Fasciotomy -Osteotomy=surgical cutting of bone -Arthroplasty=surgical repair of a joint -Arthrodesis=surgical fusion of a joint
Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? -"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." -"The continuous passive motion device can decrease the development of adhesions." -"Monitoring skin integrity is important while the continuous passive motion device is in place." -"Bleeding is a complication associated with the continuous passive motion device."
"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device."
Which intervention should the nurse implement with the client who has undergone a hip replacement? -Instruct the client to avoid internal rotation of the leg. -Adduct the legs by placing a pillow between the legs. -Place the client in high Fowler's position for meals. -Have the client bend forward to rise from the chair.
-Instruct the client to avoid internal rotation of the leg.
A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? -Assess the client's level of consciousness. -Teach the client how to prevent problems caused by immobility. -Remove the traction at least every 8 hours. -Apply the traction straps snugly.
-Teach the client how to prevent problems caused by immobility.
A nurse is reviewing a patient's activities of daily living prior to discharge from total hip replacement. The nurse should identify what activity as posing a potential risk for hip dislocation? A) Straining during a bowel movement B) Bending down to put on socks C) Lifting items above shoulder level D) Transferring from a sitting to standing position
Ans: B Feedback: Bending to put on socks or shoes can cause hip dislocation. None of the other listed actions poses a serious threat to the integrity of the new hip.
The nurse is caring for a patient who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis? A) Keep the affected leg in a position of adduction. B) Have the patient reposition himself independently. C) Protect the affected leg from internal rotation. D) Keep the hip flexed by placing pillows under the patient's knee.
Ans: C Feedback: Abduction of the hip helps to prevent dislocation of a new hip joint. Rotation and adduction should be avoided. While the hip may be flexed slightly, it shouldn't exceed 90 degrees and maintenance of flexion isn't necessary. The patient may not be capable of safe independent repositioning at this early stage of recovery.
A nurse is caring for a patient who is recovering in the hospital following orthopedic surgery. The nurse is performing frequent assessments for signs and symptoms of infection in the knowledge that the patient faces a high risk of what infectious complication? A) Cellulitis B) Septic arthritis C) Sepsis D) Osteomyelitis
Ans: D Feedback: Infection is a risk after any surgery, but it is of particular concern for the postoperative orthopedic patient because of the risk of osteomyelitis. Orthopedic patients do not have an exaggerated risk of cellulitis, sepsis, or septic arthritis when compared to other surgical patients.
Which type of cast encloses the truck and a lower extremity? a) Short-leg b) Hip spica c) Body Cast d) Long-leg
b) Hip spica
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." - "CPM strengthens the muscles of the leg." - "CPM prevents injury by limiting flexion of the knee." -"CPM delivers analgesic agents directly into the joint."
"CPM increases range of motion of the joint."
A patient was brought to the emergency department after a fall. The patient is taken to the operating room to receive a right hip prosthesis. In the immediate postoperative period, what health education should the nurse emphasize? A) "Make sure you don't bring your knees close together." B) "Try to lie as still as possible for the first few days." C) "Try to avoid bending your knees until next week." D) "Keep your legs higher than your chest whenever you can."
Ans: A Feedback: After receiving a hip prosthesis, the affected leg should be kept abducted. Mobility should be encouraged within safe limits. There is no need to avoid knee flexion and the patient's legs do not need to be higher than the level of the chest.
A nurse is planning the care of a patient who will require a prolonged course of skeletal traction. When planning this patient's care, the nurse should prioritize interventions related to which of the following risk nursing diagnoses? A) Risk for Impaired Skin Integrity B) Risk for Falls C) Risk for Imbalanced Fluid Volume D) Risk for Aspiration
Ans: A Feedback: Impaired skin integrity is a high-probability risk in patients receiving traction. Falls are not a threat, due to the patient's immobility. There are not normally high risks of fluid imbalance or aspiration associated with traction.
A nurse is caring for a patient who is postoperative day 1 right hip replacement. How should the nurse position the patient? A) Keep the patient's hips in abduction at all times. B) Keep hips flexed at no less than 90 degrees. C) Elevate the head of the bed to high Fowler's. D) Seat the patient in a low chair as soon as possible.
Ans: A Feedback: The hips should be kept in abduction by an abductor pillow. Hips should not be flexed more than 90 degrees, and the head of bed should not be elevated more than 60 degrees. The patient's hips should be higher than the knees; as such, high seat chairs should be used.
A nurse is emptying an orthopedic surgery patient's closed suction drainage at the end of a shift. The nurse notes that the volume is within expected parameters but that the drainage has a foul odor. What is the nurse's best action? A) Aspirate a small amount of drainage for culturing. B) Advance the drain 1 to 1.5 cm. C) Irrigate the drain with normal saline. D) Inform the surgeon of this finding.
Ans: D Feedback: The nurse should promptly notify the surgeon of excessive or foul-smelling drainage. It would be inappropriate to advance the drain, irrigate the drain, or aspirate more drainage.
Which interventions should a nurse implement as part of initial pain relief for the client with a cast? Select all that apply. a) Elevate the involved part b) Administer analgesics c) Apply cold packs d) Provide passive ROM e) Apply a new cast
a) Elevate the involved part b) administer analgesics c) apply cold packs
The nurse is admitting a client who is to undergo an open reduction with internal fixation for a fractured femur. About which comment should the nurse be most concerned? -" The surgeon can see the bones when putting them in correct position." -"A joint replacement or bone graft is not necessary." -"The surgeon is planning to use a metal plate and screws to fix my hip." -"The surgeon is planning to use a metal plate and screws to fix my hip." -" I was worried I would have an incision and scar."
I was worried I would have an incision and scar."
The nurse assesses a client after total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. why is the priority action of the nurse? -Apply Bucks traction. -Notify the health care provider. -Bend the knee and rotate the knee internally. -Externally rotate the extremity.
Notify the health care provider.
A nurse is admitting a patient to the unit who presented with a lower extremity fracture. What signs and symptoms would suggest to the nurse that the patient may have aperoneal nerve injury? A) Numbness and burning of the foot B) Pallor to the dorsal surface of the foot C) Visible cyanosis in the toes D) Inadequate capillary refill to the toes
Ans: A Feedback: Peroneal nerve injury may result in numbness, tingling, and burning in the feet. Cyanosis, pallor, and decreased capillary refill are signs of inadequate circulation.
A nurse is caring for a patient in skeletal traction. In order to prevent bony fragments from moving against one another, the nurse should caution the patient against which of the following actions? A) Shifting one's weight in bed B) Bearing down while having a bowel movement C) Turning from side to side D) Coughing without splinting
Ans: C Feedback: To prevent bony fragments from moving against one another, the patient should not turn from side to side; however, the patient may shift position slightly with assistance. Bearing down and coughing do not pose a threat to bone union.
Which statement is accurate regarding care of a plaster cast? a) A dry plaster cast is dull and gray b) The cast can be dented while it is damp c) The cast must be covered with a blanket to keep it moist during the first 24 hours d) The cast will dry in about 12 hours
b) The cast can be dented while it is damp.
Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? a) It prevents infection and controls edema and bleeding. b) It promotes healing by immobilizing the knee joint. c) It promotes healing by increasing circulation and movement of the knee joint. d) It provides active ROM.
c) It promotes healing by increasing circulation and mvmt of the knee joint.
A patient has recently been admitted to the orthopedic unit following total hip arthroplasty. The patient has a closed suction device in place and the nurse has determined that there were 320 mL of output in the first 24 hours. How should the nurse best respond to this assessment finding? A) Inform the primary care provider promptly. B) Document this as an expected assessment finding. C) Limit the patient's fluid intake to 2 liters for the next 24 hours. D) Administer a loop diuretic as ordered.
Ans: B Feedback: Drainage of 200 to 500 mL in the first 24 hours is expected. Consequently, the nurse does not need to inform the physician. Fluid restriction and medication administration are not indicated.
A nurse is planning the care of a patient who has undergone orthopedic surgery. What main goal should guide the nurse's choice of interventions? A) Improving the patient's level of function B) Helping the patient come to terms with limitations C) Administering medications safely D) Improving the patient's adherence to treatment
Ans: A Feedback: Improving function is the overarching goal after orthopedic surgery. Some patients may need to come to terms with limitations, but this is not true of every patient. Safe medication administration is imperative, but this is not a goal that guides other aspects of care. Similarly, adherence to treatment is important, but this is motivated by the need to improve functional status.
The nurse educator on an orthopedic trauma unit is reviewing the safe and effective use of traction with some recent nursing graduates. What principle should the educator promote? A) Knots in the rope should not be resting against pulleys. B) Weights should rest against the bed rails. C) The end of the limb in traction should be braced by the footboard of the bed. D) Skeletal traction may be removed for brief periods to facilitate the patient's independence.
Ans: A Feedback: Knots in the rope should not rest against pulleys, because this interferes with traction. Weights are used to apply the vector of force necessary to achieve effective traction and should hang freely at all times. To avoid interrupting traction, the limb in traction should not rest against anything. Skeletal traction is never interrupted.
The nursing care plan for a patient in traction specifies regular assessments for venous thromboembolism (VTE). When assessing a patient's lower limbs, what sign or symptom is suggestive of deep vein thrombosis (DVT)? A) Increased warmth of the calf B) Decreased circumference of the calf C) Loss of sensation to the calf D) Pale-appearing calf
Ans: A Feedback: Signs of DVT include increased warmth, redness, swelling, and calf tenderness. These findings are promptly reported to the physician for definitive evaluation and therapy. Signs and symptoms of a DVT do not include a decreased circumference of the calf, a loss of sensation in the calf, or a pale-appearing calf.
A nurse is caring for an older adult patient who is preparing for discharge following recovery from a total hip replacement. Which of the following outcomes must be met prior to discharge? A) Patient is able to perform ADLs independently. B) Patient is able to perform transfers safely. C) Patient is able to weight-bear equally on both legs. D) Patient is able to demonstrate full ROM of the affected hip.
Ans: B Feedback: The patient must be able to perform transfers and to use mobility aids safely. Each of the other listed goals is unrealistic for the patient who has undergone recent hip replacement.
Which would be contraindicated as a component of self-care activities for the client with a cast? a) Do not attempt to scratch the skin under a cast b) Cushioning rough edges of the cast with tape c) Cover the cast with plastic to insulate it d) Elevate the casted extremity to heart level frequently
c) Cover the cast with plastic to insulate it The cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin.
Which is an inaccurate principle of traction? a) The weights are not removed unless intermittent treatment is prescribed. b) The weights must hang freely c) The client must be in good alignment in the center of the bed d) Skeletal traction is interrupted to turn and reposition the client.
d) Skeletal traction is interrupted to turn and reposition the client. **Skeletal traction is never interrupted.
A patient broke his arm in a sports accident and required the application of a cast. Shortly following application, the patient complained of an inability to straighten his fingers and was subsequently diagnosed with Volkmann contracture. What pathophysiologic process caused this complication? A) Obstructed arterial blood flow to the forearm and hand B) Simultaneous pressure on the ulnar and radial nerves C) Irritation of Merkel cells in the patient's skin surfaces D) Uncontrolled muscle spasms in the patient's forearm
Ans: A Feedback: Volkmann contracture occurs when arterial blood flow is restricted to the forearm and hand and results in contractures of the fingers and wrist. It does not result from nerve pressure, skin irritation, or spasms.
A nurse is caring for a patient receiving skeletal traction. Due to the patient's severe limits on mobility, the nurse has identified a risk for atelectasis or pneumonia. What intervention should the nurse provide in order to prevent these complications? A) Perform chest physiotherapy once per shift and as needed. B) Teach the patient to perform deep breathing and coughing exercises. C) Administer prophylactic antibiotics as ordered. D) Administer nebulized bronchodilators and corticosteroids as ordered.
Ans: B Feedback: To prevent these complications, the nurse should educate the patient about performing deep-breathing and coughing exercises to aid in fully expanding the lungs and clearing pulmonary secretions. Antibiotics, bronchodilators, and steroids are not used on a preventative basis and chest physiotherapy is unnecessary and implausible for a patient in traction.
A nurse is assessing a patient who is receiving traction. The nurse's assessment confirms that the patient is able to perform plantar flexion. What conclusion can the nurse draw from this finding? A) The leg that was assessed is free from DVT. B) The patient's tibial nerve is functional. C) Circulation to the distal extremity is adequate. D) The patient does not have peripheral neurovascular dysfunction.
Ans: B Feedback: Plantar flexion demonstrates function of the tibial nerve. It does not demonstrate the absence of DVT and does not allow the nurse to ascertain adequate circulation. The nurse must perform more assessments on more sites in order to determine an absence of peripheral neurovascular dysfunction.
The nurse has identified the diagnosis of Risk for Impaired Tissue Perfusion Related to Deep Vein Thrombosis in the care of a patient receiving skeletal traction. What nursing intervention best addresses this risk? A) Encourage independence with ADLs whenever possible. B) Monitor the patient's nutritional status closely. C) Teach the patient to perform ankle and foot exercises within the limitations of traction. D) Administer clopidogrel (Plavix) as ordered.
Ans: C Feedback: The nurse educates the patient how to perform ankle and foot exercises within the limits of the traction therapy every 1 to 2 hours when awake to prevent DVT. Nutrition is important, but does not directly prevent DVT. Similarly, independence with ADLs should be promoted, but this does not confer significant prevention of DVT, which often affects the lower limbs. Plavix is not normally used for DVT prophylaxis.
A nurse is caring for a patient who has had a plaster arm cast applied. Immediately postapplication, the nurse should provide what teaching to the patient? A) The cast will feel cool to touch for the first 30 minutes. B) The cast should be wrapped snuggly with a towel until the patient gets home. C) The cast should be supported on a board while drying. D) The cast will only have full strength when dry.
Ans: D Feedback: A cast requires approximately 24 to 72 hours to dry, and until dry, it does not have full strength. While drying, the cast should not be placed on a hard surface. The cast will exude heat while it dries and should not be wrapped.
The nurse teaching the client with a cast about home care includes which instruction? a) Cover the cast with plastic or rubber b) Keep the cast below heart level c) Fix a broken cast by applying tape d) Dry a wet fiberglass cast thoroughly to avoid skin problems
d) Dry a wet fiberglass cast thoroughly to avoid skin problems **Teach the client to keep the cast dry, to dry a wet fiberglass cast thoroughly to avoid skin problems, and not to cover it with plastic or rubber. -A cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin.
A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied? -Long leg cast -Short leg cast -Hip spica cast -Walking cast
Short leg cast
A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse? "It is best if an orthopedic doctor applies the cast." "A splint is applied when more swelling is expected at the site of injury." "Not all fractures require a cast." "You would have to stay here much longer because it takes a cast longer to dry."
"A splint is applied when more swelling is expected at the site of injury."
A client is seen in the emergency department for an injury acquired from falling off 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 nurses why a splint is applied and not a cast. What is the best explanation by the nurse? -"You will be able to wear the splint longer than you would a cast." -"The arm does not require the same immobilization that a leg fracture would." -"We will need to monitor the status of the laceration to be sure it does not get infected." -" The splint is less expensive than the cast."
"We will need to monitor the status of the laceration to be sure it does not get infected."
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? -More breathable -Longer lasting -Quicker drying -Better molding to the client
-Better molding to the client
The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.) -Decreased sensory function -Capillary refill less than 3 seconds -Loss of motion -2+ peripheral pulses in the affected distal pulse -Excruciating pain
-Decreased sensory function -Loss of motion -Excruciating pain
The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? -Pulmonary embolism -Atelectasis -Urinary tract infection -Hypovolemia
-Pulmonary embolism
A patient has suffered a muscle strain and is complaining of pain that she rates at 6 on a 10-point scale. The nurse should recommend what action? A) Taking an opioid analgesic as ordered B) Applying a cold pack to the injured site C) Performing passive ROM exercises D) Applying a heating pad to the affected muscle
Ans: B Feedback: Most pain can be relieved by elevating the involved part, applying cold packs, and administering analgesics as prescribed. Heat may exacerbate the pain by increasing blood circulation, and ROM exercises would likely be painful. Analgesia is likely necessary, but NSAIDs would be more appropriate than opioids.
The orthopedic surgeon has prescribed balanced skeletal traction for a patient. What advantage is conferred by balanced traction? A) Balanced traction can be applied at night and removed during the day. B) Balanced traction allows for greater patient movement and independence than other forms of traction. C) Balanced traction is portable and may accompany the patient's movements. D) Balanced traction facilitates bone remodeling in as little as 4 days.
Ans: B Feedback: Often, skeletal traction is balanced traction, which supports the affected extremity, allows for some patient movement, and facilitates patient independence and nursing care while maintaining effective traction. It is not portable, however, and it cannot be removed. Bone remodeling takes longer than 4 days.
While assessing a patient who has had knee replacement surgery, the nurse notes that the patient has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this patient? A) Risk for Infection B) Risk for Peripheral Neurovascular Dysfunction C) Unilateral Neglect D) Disturbed Kinesthetic Sensory Perception
Ans: B Feedback: The hematoma may cause an interruption of tissue perfusion, so the most appropriate nursing diagnosis is Risk of Peripheral Neurovascular Dysfunction. There is also an associated risk for infection because of the hematoma, but impaired neurovascular function is a more acute threat. Unilateral neglect and impaired sensation are lower priorities than neurovascular status.
A patient with a right tibial fracture is being discharged home after having a cast applied. What instruction should the nurse provide in relationship to the patient's cast care? A) "Cover the cast with a blanket until the cast dries." B) "Keep your right leg elevated above heart level." C) "Use a clean object to scratch itches inside the cast." D) "A foul smell from the cast is normal after the first few days."
Ans: B Feedback: The leg should be elevated to promote venous return and prevent edema. The cast shouldn't be covered while drying because this will cause heat buildup and prevent air circulation. No foreign object should be inserted inside the cast because of the risk of cutting the skin and causing an infection. A foul smell from a cast is never normal and may indicate an infection.
A patient has just begun been receiving skeletal traction and the nurse is aware that muscles in the patient's affected limb are spastic. How does this change in muscle tone affect the patient's traction prescription? A) Traction must temporarily be aligned in a slightly different direction. B) Extra weight is needed initially to keep the limb in proper alignment. C) A lighter weight should be initially used. D) Weight will temporarily alternate between heavier and lighter weights.
Ans: B Feedback: The traction weights applied initially must overcome the shortening spasms of the affected muscles. As the muscles relax, the traction weight is reduced to prevent fracture dislocation and to promote healing. Weights never alternate between heavy and light.
A patient with a total hip replacement is progressing well and expects to be discharged tomorrow. On returning to bed after ambulating, he complains of a new onset of pain at the surgical site. What is the nurse's best action? A) Administer pain medication as ordered. B) Assess the surgical site and the affected extremity. C) Reassure the patient that pain is a direct result of increased activity. D) Assess the patient for signs and symptoms of systemic infection.
Ans: B Feedback: Worsening pain after a total hip replacement may indicate dislocation of the prosthesis. Assessment of pain should include evaluation of the wound and the affected extremity. Assuming he's anxious about discharge and administering pain medication do not address the cause of the pain. Sudden severe pain is not considered normal after hip replacement. Sudden pain is rarely indicative of a systemic infection.
An elderly patient's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment? A) The presence of leg shortening B) The patient's complaints of pain C) Signs of neurovascular compromise D) The presence of internal or external rotation
Ans: C Feedback: Because impaired circulation can cause permanent damage, neurovascular assessment of the affected leg is always a priority assessment. Leg shortening and internal or external rotation are common findings with a fractured hip. Pain, especially on movement, is also common after a hip fracture.
A patient is admitted to the unit in traction for a fractured proximal femur and requires traction prior to surgery. What is the most appropriate type of traction to apply to a fractured proximal femur? A) Russell's traction B) Dunlop's traction C) Buck's extension traction D) Cervical head halter
Ans: C Feedback: Buck's extension is used for fractures of the proximal femur. Russell's traction is used for lower leg fractures. Dunlop's traction is applied to the upper extremity for supracondylar fractures of the elbow and humerus. Cervical head halters are used to stabilize the neck.
A nurse is caring for a patient who has a leg cast. The nurse observes that the patient uses a pencil to scratch the skin under the edge of the cast. How should the nurse respond to this observation? A) Allow the patient to continue to scratch inside the cast with a pencil but encourage him to be cautious. B) Give the patient a sterile tongue depressor to use for scratching instead of the pencil. C) Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching persists. D) Obtain an order for a sedative, such as lorazepam (Ativan), to prevent the patient from scratching.
Ans: C Feedback: Scratching should be discouraged because of the risk for skin breakdown or damage to the cast. Most patients can be discouraged from scratching if given a mild antihistamine, such as diphenhydramine, to relieve itching. Benzodiazepines would not be given for this purpose.
A nurse is providing discharge education to a patient who is going home with a cast on his leg. What teaching point should the nurse emphasize in the teaching session? A) Using crutches efficiently B) Exercising joints above and below the cast, as ordered C) Removing the cast correctly at the end of the treatment period D) Reporting signs of impaired circulation
Ans: D Feedback: Reporting signs of impaired circulation is critical; signs of impaired circulation must be reported to the physician immediately to prevent permanent damage. For this reason, this education is a priority over exercise and crutch use. The patient does not independently remove the cast.
A nurse is assessing the neurovascular status of a patient who has had a leg cast recently applied. The nurse is unable to palpate the patient's dorsalis pedis or posterior tibial pulse and the patient's foot is pale. What is the nurse's most appropriate action? A) Warm the patient's foot and determine whether circulation improves. B) Reposition the patient with the affected foot dependent. C) Reassess the patient's neurovascular status in 15 minutes. D) Promptly inform the primary care provider.
Ans: D Feedback: Signs of neurovascular dysfunction warrant immediate medical follow-up. It would be unsafe to delay. Warming the foot or repositioning the patient may be of some benefit, but the care provider should be informed first.
A nurse is caring for a patient who has had a total hip replacement. The nurse is reviewing health education prior to discharge. Which of the patient's statements would indicate to the nurse that the patient requires further teaching? A) "I'll need to keep several pillows between my legs at night." B) "I need to remember not to cross my legs. It's such a habit." C) "The occupational therapist is showing me how to use a 'sock puller' to help me get dressed." D) "I will need my husband to assist me in getting off the low toilet seat at home."
Ans: D Feedback: To prevent hip dislocation after a total hip replacement, the patient must avoid bending the hips beyond 90 degrees. Assistive devices, such as a raised toilet seat, should be used to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Likewise, teaching the patient to avoid crossing the legs also reduces the risk of hip dislocation. A sock puller helps a patient get dressed without flexing the hips beyond 90 degrees.
A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? -Scrub the area vigorously to remove the crust. -Apply lotions and take warm baths or soaks. -Avoid exposure to direct sunlight. -Consult a skin specialist.
Apply lotions and take warm baths or soaks.
Which nursing action would help prevent deep vein thrombosis in a client who has had an orthopedic surgery? -Instruct about exercise, as prescribed -Instruct about using client-controlled analgesia, if prescribed -Apply anti embolism stockings -Apply cold packs
Apply ant-embolism stockings
A client with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? Select all that apply. -Assess for a pressure sore -Administer a prescribed analgesic to promote comfort and allay anxiety. -Assess the fingers for color and temperature. -Cut the cast with a cast saw -Determine the exact site of the pain.
Assess for a pressure sore Assess the fingers for color and temperature. Determine the exact site of the pain.
Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? -It provides active range of motion -It promotes healing by immobilizing the knee joint -It prevents infection and controls edema and bleeding -It promotes healing by increasing circulation and movement of the knee joint.
It promotes healing by increasing circulation and movement of the knee joint
A client is seen in the orthopedic clinic for complaints 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 arthroscopy -Closed reduction of the left hip. -Open reduction and internal fixation of the left hip. -Left hip arthroplasty
Left hip arthroplasty
After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority? -Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use -Maintaining traction continuously to ensure its effectiveness -Monitoring the client for skin breakdown -Supporting the traction weights with a chair or table to prevent accidental slippage
Maintaining traction continuously to ensure its effectiveness
A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identify this as? -Internal fixation -Open reduction -Buck's traction -Skeletal traction
Open reduction
Which is an inaccurate principle of traction -The weights hang freely -The client must be in good alignment in the center of the bed. -The weights are not removed unless intermittent treatment is prescribed. -Skeletal traction is interrupted to turn an deposition that client.
Skeletal traction is interrupted to turn an deposition that client.
Which statement describes external fixation? -The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. -The bone is surgically exposed and realigned. -The bone is restored to its normal position by external manipulation. -The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.
The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.
Which cleansing solution is the most effective for use in completing pin site care? a) Betadine b) Chlorhexidine c)Alcohol d) Hydrogen Peroxide
b) Chlorhexidine Chlorhexidine solution is recommended as the most effective cleansing solution; however water and saline are alternate choices .
The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery? a) Avoid placing a pillow between the legs when sleeping b) Keep the knees together at all times c) Bend forward only when seated in a chair d) Never cross the affected leg when seated
d) Never cross the affected leg when seated