Chapter 40 Prepu

A client with a right tibial fracture is being discharged home after having a cast applied. What instruction should the nurse provide in relationship to the client's cast care?

"Cover the cast with a blanket until the cast dries." "Keep your right leg elevated above heart level." "Use a clean object to scratch itches inside the cast." "A foul smell from the cast is normal after the first few days."

A client diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse?

"This allows for the strength in the arm to remain consistent." "The joint above the fracture and below the fracture must be immobilized." "When a spica cast is ordered, the arm must be immobilized." "The method allows for the fastest healing time and the greatest mobility."

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

"We will need to monitor the status of the laceration to be sure it does not get infected." "The arm does not require the same immobilization that a leg fracture would." "You will be able to wear the splint longer than you would a cast." "The splint is less expensive than the cast."

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain?

A dull, deep, boring ache Sharp and piercing Similar to "muscle cramps" Sore and aching

A client with a total hip replacement is progressing well and expects to be discharged tomorrow. On returning to bed after ambulating, the client reports a new onset of pain at the surgical site. What is the nurse's best action?

Administer pain medication as prescribed. Assess the surgical site and the affected extremity. Reassure the client that pain is a direct result of increased activity. Assess the client for signs and symptoms of systemic infection.

A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client?

Advising the client to avoid red meat Urging her to keep the affected limb in an elevated position Educating the client about the effects of menopause Exploring factors related to the client's home environment

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

An open reduction A fasciotomy A total hip replacement A total knee replacement

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. What is the priority action of the nurse?

Apply Buck's traction. Notify the health care provider. Externally rotate the extremity. Bend the knee and rotate the knee internally.

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture?

Arthrodesis Joint arthroplasty Total joint arthroplasty Open reduction

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

Balanced traction can be applied at night and removed during the day. Balanced traction allows for greater client movement and independence than other forms of traction. Balanced traction is portable and may accompany the client's movements. Balanced traction facilitates bone remodeling in as little as 6 days.

The nurse is assigned to care for a client who has had an open reduction and internal fixation of a fractured right femur 2 days ago. The nurse is listening to the client's lungs and, when moving the gown, observes petechial hemorrhages on the skin of the chest. What is the first action by the nurse?

Call the physician to inform them of the findings. Administer pain medication. Request an antihistamine for the allergic reaction. Increase the intravenous fluids for hemorrhage.

The nurse is caring for a client who has had a fracture reduction using a cast. What is most important for the nurse to assess?

Cardiac status Renal function Sleep status Neurovascular status

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?

Consult a skin specialist. Scrub the area vigorously to remove the crust. Apply lotions and take warm baths or soaks. Avoid exposure to direct sunlight.

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 antiembolism stockings as indicated.

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

Have the patient extend both hands while the nurse compares the volume of both radial pulses. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength.

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?

Hypovolemic shock Osteomyelitis Urinary retention Atelectasis

A nurse is planning the care of a client who has undergone orthopedic surgery. What main goal should guide the nurse's choice of interventions?

Improving the client's level of function Helping the client come to terms with limitations Administering medications safely Improving the client's adherence to treatment

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. Place the client in high Fowler's position for meals. Have the client bend forward to rise from the chair. Adduct the legs by placing a pillow between the legs.

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 increasing circulation and movement of the knee joint. It promotes healing by immobilizing the knee joint. It prevents infection and controls edema and bleeding.

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

Keep the affected leg in a position of adduction. Have the client reposition himself independently. Protect the affected leg from internal rotation. Keep the hip flexed by placing pillows under the client's knee.

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority?

Monitoring the client for skin breakdown Maintaining traction continuously to ensure its effectiveness Supporting the traction weights with a chair or table to prevent accidental slippage Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use

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

Providing crutches to the client. Assisting in early ambulation. Using a continuous passive motion (CPM) machine. Encouraging expressions of anxiety.

A nurse is planning the care of a client who will require a prolonged course of skeletal traction. When planning this client's care, the nurse should prioritize interventions related to what risk nursing diagnosis?

Risk for Impaired Skin Integrity Risk for Falls Risk for Imbalanced Fluid Volume Risk for Aspiration

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 Disturbed body image Situational low self-esteem Risk for avascular necrosis of the joint

The nurse is caring for a client with an external fixator that requires pin care twice a day. The nurse observes that there is a new purulent drainage around one of the pins. What intervention should the nurse anticipate doing?

Scrubbing the drainage from around the pin site Obtaining a culture Applying iodine-based solution Apply ointment to the pin site.

A nurse is reviewing a client'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?

Straining during a bowel movement Bending down to put on socks Lifting items above shoulder level Transferring from a sitting to standing position

A nurse is caring for a client who has had a plaster arm cast applied. Immediately after application, the nurse should provide what teaching to the client?

The cast will feel cool to touch for the first 30 minutes. The cast should be wrapped snuggly with a towel until the client gets home. The cast should be supported on a board while drying. The cast will only have full strength when dry.

A nurse is providing discharge education to a client who is going home with a cast on his leg. What topic should the nurse emphasize in the teaching session?

Using crutches efficiently Exercising joints above and below the cast, as prescribed Removing the cast correctly at the end of the treatment period Reporting signs of impaired circulation

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

Using crutches properly Exercising joints above and below the cast, as ordered Avoiding walking on a leg cast without the health care provider's permission Reporting signs of impaired circulation

A nurse is assessing the neurovascular status of a client who has had a leg cast recently applied. The nurse is unable to palpate the client's dorsalis pedis or posterior tibial pulse and the client's foot is pale. What is the nurse's most appropriate action?

Warm the client's foot and determine whether circulation improves. Reposition the client with the affected foot dependent. Reassess the client's neurovascular status in 15 minutes. Promptly inform the primary provider.

The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery?

Keep the knees together at all times Never cross the affected leg when seated Avoid placing a pillow between the legs when sleeping Bend forward only when seated in a chair

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan?

Keeping the casted arm warm by covering it with a light blanket Avoiding handling the cast for 24 hours or until it is dry Evaluating pedal and posterior tibial pulses every 2 hours Assessing movement and sensation in the fingers of the right hand

Which intervention should the nurse implement with the client who has an external fixator? Select all that apply.

Perform pin care as ordered. Turn the clamps by one-half every day. Supervise the client during transfers. Perform neurovascular assessment. Inspect pin sites for signs of infection.

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?

Permanent paresthesias Foot drop Deep vein thrombosis (DVT) Infection

While assessing a client who has had knee replacement surgery, the nurse notes that the client 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 client?

Risk for Infection Risk for Ineffective Peripheral Tissue Perfusion Unilateral Neglect Related to Hematoma Disturbed Kinesthetic Sensory Perception

The client is admitted to the hospital with a diagnosis of left femoral neck fracture. Which treatment modality would the nurse expect the health care provider to order?

Buck's traction Casting External fixator Skeletal traction

A nurse would most likely expect the need for open reduction for a client with which of the following?

Closed fracture Little bone separation Soft tissue free of bone ends Joint fracture

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply.

Surgery will not be required. Muscle spasms will be relieved. The bones of the left leg will be aligned. Immobilization of the left leg will be maintained. Less pain medication will be required.

A client with a right leg fracture is returning to the orthopedist to have the cast removed. What would the physician prescribe as further treatment?

physical therapy discontinue use of crutches cold compresses to leg for swelling No options are correct.

A client is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The client is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement?

"Actually, clients are only on bed rest for 2 to 3 days before they begin walking with assistance." "The physical therapist will likely help you get up using a walker the day after your surgery." "Our goal will actually be to have you walking normally within 5 days of your surgery." "For the first 2 weeks after the surgery, you can use a wheelchair to meet your mobility needs."

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 delivers analgesic agents directly into the joint." "CPM prevents injury by limiting flexion of the knee."

Which is an inappropriate use of traction?

Immobilize a fracture Decrease space between opposing structures Reduce deformity Minimize muscle spasms

To prepare a client who has a fractured femur for ambulation, the nurse teaches the client how to do quadriceps setting exercises. Which instruction is the most accurate?

"Contract and relax your buttocks." "Try to lift your legs up when I press against your feet." "Press the back of your knee against the bed." "Flex and extend your toes."

The nurse is admitting a client who is to undergo an open reduction with internal fixation for a fractured femur. About which comment by the client should the nurse be most concerned?

"I was worried I would have an incision and scar." "The surgeon is planning to use a metal plate and screws to fix my hip." "A joint replacement or bone graft is not necessary." "The surgeon can see the bones when putting them in correct position."

Which type of cast encloses the trunk and a lower extremity?

Body cast Hip spica Long-leg Short-leg

Which device is designed specifically to support and immobilize a body part in a desired position?

Brace Sling Splint Traction

Which of the following would the nurse expect a physician to use on a short-term basis for a client with an injured body part that does not require rigid immobilization?

Cast Brace Splint Skin traction

The nurse is providing instructions to the client following application of a fiberglass cast. Which statement by the client indicates further education is needed?

"Under no circumstances should I get my cast wet." "The cast should not come in contact with other plastics." "I should avoid touching the cast while it is wet." "The cast will be hot while it is drying."

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.)

"You may cross your legs at the ankles only." "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." "It is okay to briefly flex the hip to put on your clothes."

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?

"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." "It is best if an orthopedic doctor applies the cast." "Not all fractures require a cast."

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker?

24 hours 72 hours 1 week 2 to 3 weeks

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 Removal of the cast Insertion of an external fixator

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 Excruciating pain Loss of motion Capillary refill less than 3 seconds 2+ peripheral pulses in the affected distal pulse

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?

Explain that the sensation being felt is normal and will not burn the client. Remove the cast immediately, notifying the physician. Administer antianxiety and pain medication. Call for assistance to hold the client in the required position until the cast has dried.

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective?

"Metal pins will go through my skin to the bone." "I will wear a boot with weights attached." "A belt will go around my pelvis and weights will be attached." "The traction can be removed once a day so I can shower."

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 toes are pink." "My cast is still wet." "My pain is a 3."

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

Maintaining pin care. Planning the client's diet. Monitoring the client's urine output. Monitoring the client's blood pressure.

A client with a tibia fracture was placed in an external fixator 24 hours ago. The nurse is completing pin care and notices redness at the pin site and a small amount of serous drainage. What action by the nurse is appropriate?

Notify the physician. Document the findings. Prepare for surgical removal of the fixator. Assess the client's hemoglobin and hematocrit.

A nurse is admitting a client to the unit who presented with a lower extremity fracture. What signs and symptoms would suggest to the nurse that the client may have a peroneal nerve injury?

Numbness and burning of the foot Pallor to the dorsal surface of the foot Visible cyanosis in the toes Inadequate capillary refill to the toes

A client was playing softball and dislocated four of his fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as?

Open reduction Closed reduction Open reduction with internal fixation External fixation

Which of the following is an inappropriate nursing diagnosis for the client following casting?

Risk for deficient knowledge: procedure Risk for impaired tissue perfusion Risk for impaired skin integrity Risk for disuse syndrome

Conservative treatment of a compressed nerve root is first line treatment. What conservative treatment is used to increase the distance between vertebrae and decrease severe muscle spasm?

Skeletal traction Sleeping on a hard mattress with a bed board Cool, moist compresses Skin traction

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.)

Apply an emollient lotion to soften the skin. Control swelling with elastic bandages, as directed. Gradually resume activities and exercise. Use friction to remove dead surface skin by rubbing the area with a towel. Use a razor to shave the dead skin off.

A nurse is emptying an orthopedic surgery client'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?

Aspirate a small amount of drainage for culturing. Advance the drain 1 to 1.5 cm. Irrigate the drain with normal saline. Inform the surgeon of this finding.

Which statement is accurate regarding care of a plaster cast?

The cast must be covered with a blanket to keep it moist during the first 24 hours. The cast will dry in about 12 hours. The cast can be dented while it is damp. A dry plaster cast is dull and gray.

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

The physician orders the amount of extension and flexion produced by the machine. The physician orders the frequency of use of the machine. The amount of flexion for clients with hip replacements should never exceed 30 degrees in the CPM machine. The amount of flexion for clients with hip replacements should never exceed 60 degrees in the CPM machine.

Which principle applies to the client in traction?

Weights should rest on the bed. Skeletal traction is never interrupted. Knots in the ropes should touch the pulley. Weights are removed routinely.

Which intervention would the nurse implement with the client in a plaster cast? Select all that apply.

Protect wet cast by covering with sheet. Handle wet cast with palms of hands. Notify health care provider, if client reports warmth of the cast. Position casted extremity firmly on a hard surface while drying. Trim, reshape, and smooth edges of cast.

A nurse is caring for a client in skin traction. In order to prevent bony fragments from moving against one another, the nurse should caution the client against performing what action?

Shifting one's weight in bed Bearing down while having a bowel movement Turning from side to side Coughing without splinting

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

Within 30 minutes, then every 1 to 2 hours Within 30 minutes, then every 4 hours Within 30 minutes, then every 8 hours Within 30 minutes, then every shift

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

osteomyelitis hematoma hemorrhage infection

A client reports swelling and severe pain in the right wrist. After examination and radiographs negate a fracture, what would the physician likely prescribe as treatment?

splint brace cast All options are correct.

A client with a right leg fracture is returning to the orthopedist to have the cast removed. During cast removal, it is important for the nurse to assure:

the client that he or she won't be cut. that the cast cutter blade is new. that pedal pulses are present. that the leg will be as good as new.

Which device is designed specifically to initially support and immobilize a body part in a desired position until swelling subsides?

Brace Continuous passive motion (CPM) device Splint Trapeze

A nurse is caring for a client with a cast on the left arm after sustaining a fracture. Which assessment finding is most significant for this client?

Fingers on the left hand are swollen and cool Presence of a normal popliteal pulse Cast edges are rough, with skin irritation present Minimal pain in the left arm

Which nursing assessment finding would be indicative of compartment syndrome in the client with a cast applied to the left forearm 3 hours earlier?

Fingers pink and warm and move freely Capillary refill of left fingers greater than 3 seconds Radial pulses palpable and +2 bilaterally Absence of numbness and tingling

A client sustained a stable fracture of the cervical spine and is having skeletal traction applied. What type of traction does the nurse educate the client about?

Kirschner wires Thomas splint Steinmann pins Crutchfield tongs

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?

Knots in the rope should not be resting against pulleys. Weights should rest against the bed rails. The end of the limb in traction should be braced by the footboard of the bed. Skeletal traction may be removed for brief periods to facilitate the client's independence.

A client is placed in traction for a femur facture. The nurse would document which expected outcomes of traction? Select all that apply.

Realignment of the fracture Decreased pedal pulse Reduction of deformity Minimization of muscle spasms Increased ability to bear weight Full range of motion to extremity

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure?

Replacement of one of the articular surfaces of a joint Incision and diversion of the muscle fascia Excision of damaged joint fibrocartilage Replacement of knee with artificial joint

A nurse is assessing a client who is receiving traction. The nurse's assessment confirms that the client is able to perform plantar flexion. What conclusion can the nurse draw from this finding?

The leg that was assessed is free from DVT. The client's tibial nerve is functional. Circulation to the distal extremity is adequate. The client does not have peripheral neurovascular dysfunction.

A client has undergone a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity? Select all that apply.

Advise the client to use a trochanter roll. Advise the client to adduct the stump so it presses against the other leg when the client is lying on the stomach. Advise the client to use antiembolism stockings on both legs. Advise the client to place pillows between the legs.

A nurse is caring for a client who has a leg cast. The nurse observes that the client uses a pencil to scratch the skin under the edge of the cast. How should the nurse respond to this observation?

Allow the client to continue to scratch inside the cast with a pencil but encourage him to be cautious. Give the client a sterile tongue depressor to use for scratching instead of the pencil. Encourage the client to avoid scratching, and obtain a prescription for an antihistamine if severe itching persists. Obtain a prescription for a sedative, such as lorazepam, to prevent the client from scratching.

A physician writes a prescription to discontinue skeletal traction on an orthopedic client. The nurse should anticipate what subsequent intervention?

Application of a walking boot Application of a cast Education on how to use crutches Passive range of motion exercises

Which interventions should a nurse implement as part of initial pain relief for the client with a cast? Select all that apply.

Apply cold packs Apply a new cast Administer analgesics Elevate the involved part Provide passive range of motion

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

Apply occlusive dressings to the pin sites. Encourage the client to push up with the elbows when repositioning. Encourage the client to perform isometric exercises once a shift. Assess the pin insertion site every 8 hours.

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?

Apply the traction straps snugly. Assess the client's level of consciousness. Remove the traction at least every 8 hours. Teach the client how to prevent problems caused by immobility.

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?

Arthrodesis Hemiarthroplasty Total arthroplasty Osteotomy

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

A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client?

Assisting with range-of-motion and isometric exercises. Changing the client's position within prescribed limits. Administering prescribed analgesics. Applying warm compresses.

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

Atelectasis Hypovolemia Pulmonary embolism Urinary tract infection

A group of students are reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?

Better molding to the client Quicker drying Longer-lasting More breathable

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?

Blood pressure of 140/90 mm Hg Crackles in the lung bases Client complains of pain in the affected rib area when taking a deep breath Heart rate of 94 beats/minute

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

Buck's traction Skeletal traction Internal fixation Open reduction

For which of the following immobility-related complications is the client in traction at risk? Select all that apply.

Cachexia Thromboemboli Urinary stasis Diarrhea Lactose intolerance

A nurse is caring for a client 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 client faces a high risk of what infectious complication?

Cellulitis Septic arthritis Sepsis Osteomyelitis

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?

Client complains of tingling and numbness in the right shoulder. Right shoulder is elevated above the left. Client complains of pain in the unaffected shoulder. Right shoulder slopes downward and droops inward.

Which evaluation finding requires follow up by the nurse caring for a client with a total knee replacement? Select all that apply.

Client reports pain rating of 2. Pedal pulses strong and equal bilaterally 650 ml bloody drainage in drain wound Knee flexion at 30 degrees Client ambulates 10 feet by postoperative day 2

The nursing care plan for a client in traction specifies regular assessments for venous thromboembolism (VTE). When assessing a client's lower limbs, what sign or symptom is suggestive of deep vein thrombosis (DVT)?

Increased warmth of the calf Decreased circumference of the calf Loss of sensation to the calf Pale-appearing calf

A client returns to the nursing unit following an open reduction with internal fixation of the right hip. Which nursing interventions would be appropriate for the prophylactic treatment of deep vein thrombosis? Select all that apply.

Increasing fluid intake Maintaining antiembolic stockings Administering enoxaparin Encouraging coughing exercises Increasing fiber intake

A client has recently been admitted to the orthopedic unit following total hip arthroplasty. The client 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?

Inform the primary provider promptly. Document this as an expected assessment finding. Limit the client's fluid intake to 2 L for the next 24 hours. Administer a loop diuretic as prescribed.

Which nursing action would help prevent deep vein thrombosis in a client who has had an orthopedic surgery?

Instruct about using client-controlled analgesia, if prescribed Instruct about exercise, as prescribed Apply antiembolism stockings Apply cold packs

Which statements describe open reduction of a fracture? Select all that apply.

It is performed in the operating room. The bone is surgically exposed and realigned. The client usually receives general or spinal anesthetic. The bone is restored to its normal position by external manipulation.

A client with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care? Select all that apply.

Elevate the arm above the heart. Prepare to remove the cast. Provide support to the injured extremity. Assess neurovascular status every 8 hours. Apply ice to extremity.

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

Place slight additional tension on the traction cords. Release the weights and replace them immediately after positioning. Reposition the bed instead of repositioning the client. Maintain consistent traction tension while repositioning.

Which actions by the nurse demonstrate an understanding of caring for a client in traction? Select all that apply.

Placing a trapeze on the bed Ensuring that the weights are hanging freely Assessing the client's alignment in the bed Removing skeletal traction to turn and reposition the client Frequently assessing pain level

The nurse is caring for a patient postoperatively following orthopedic surgery. The nurse assesses an oxygen saturation of 89%, confusion, and a rash on the upper torso. What does the nurse suspect is occurring with this patient?

Polyethylene-induced infection Pneumonia Fat emboli syndrome Disseminated intravascular coagulation

A client 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.

Preventing additional injury Immobilizing prior to surgery Providing support Controlling movement Promoting bone remodeling

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

Remove the weights during linen changes. Increase calorie intake. Reduce fluid intake. Increase fiber intake.

A client is in Buck's traction after fracturing his right hip. The nurse should include which action in the care plan?

Removing the weights once every shift Maintaining the bed in the knee gatch position Keeping the client in semi-Fowler's position Maintaining correct body alignment

A client 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?

Russell traction Dunlop traction Buck's extension traction Cervical halter

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?

Short arm cast Gauntlet cast Body cast Spica cast

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?

Short leg cast Long leg cast Walking cast Hip spica cast

A client is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm?

Use of isometric exercises Proper use of a sling Repositioning the arm in the cast Abduction and adduction of the shoulder

A client undergoes an open reduction of a femur fracture, and returns to the orthopedic unit with a cast in place. What is the rationale for frequently assessing the client's pedal pulses?

maintaining adequate circulation typical postoperative nursing management ensuring surgery was successful ensuring there wasn't nerve damage during surgery

Meniscectomy refers to the

replacement of one of the articular surfaces of a joint. incision and diversion of the muscle fascia. excision of damaged joint fibrocartilage. removal of a body part.

A client presents at the emergency department with a compound fracture of the right femur. Skeletal traction is applied to align the bones. What type of traction would be used?

Steinmann traction Buck's traction Russell traction Thomas splint

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 the fingers for color and temperature. Administer a prescribed analgesic to promote comfort and allay anxiety. Assess for a pressure sore Determine the exact site of the pain. Cut the cast with a cast saw

Which cleansing solution is the most effective for use in completing pin site care?

Betadine Chlorhexidine Hydrogen peroxide Alcohol

The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, "How can I stay like this for weeks? I can't even move!" Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis?

Ineffective Coping related to prolonged immobility Impaired Physical Mobility related to traction Deficient Diversional Activity related to prolonged hospitalization Activity Intolerance related to impaired mobility

A nurse is caring for a client receiving skeletal traction. Due to the client'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?

Perform chest physiotherapy once per shift and as needed. Teach the client to perform deep breathing and coughing exercises. Administer prophylactic antibiotics as prescribed. Administer nebulized bronchodilators and corticosteroids as prescribed.

The client presents with nausea and vomiting, sluggish bowel sounds, and abdominal distention. How does the nurse interpret these findings?

Physiologic cast syndrome Impaired physical mobility Psychological cast syndrome Disuse syndrome

A nurse is caring for a client who has had a total hip replacement. The nurse is reviewing health education prior to discharge. Which of the client's statements would indicate to the nurse that the client requires further teaching?

"I'll need to keep several pillows between my legs at night." "I need to remember not to cross my legs. It's such a habit." "The occupational therapist is showing me how to use a 'sock puller' to help me get dressed." "I will need my husband to assist me in getting off the low toilet seat at home."

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide?

"Limit hip flexion to 90 degrees." "Perform rotation exercises each day." "Intermittently cross and uncross your legs several times each day." "Avoid weight bearing until the hip is completely healed."

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." "Bleeding is a complication associated with the continuous passive motion device." "Monitoring skin integrity is important while the continuous passive motion device is in place."

The nurse is caring for a client who had a surgical amputation of the left leg related to complication from diabetes. The client asks the nurse, "If my leg is really gone, then why am I having such bad pain?" What is the best response by the nurse?

"You are only imagining that you are having pain." "It is called phantom pain and may come and go." "You will continue to have this pain, and you will have to learn to ignore it." "This is called false pain and is a brain dysfunction."

A 91-year-old client is slated for orthopedic surgery and the nurse is integrated gerontologic considerations into the client's plan of care. What intervention is most justified in the care of this client?

Administration of prophylactic antibiotics Total parenteral nutrition (TPN) Use of a pressure-relieving mattress Use of a Foley catheter until discharge

The nurse is caring for a patient with a total hip replacement. How should the nurse allow the patient to turn?

45 degrees onto the unoperated side if the affected hip is kept abducted From the prone to the supine position only, and the patient must keep the affected hip extended and abducted To any comfortable position as long as the affected leg is extended To the operative side if the affected hip remains extended

Upon reporting to work and receiving report, a nurse has been assigned to provide care for three clients. Each of the clients has called out to the nurses' station requesting assistance. Which client should the nurse see first?

A 32-year-old male, who had a plaster cast applied to his leg 2 hours ago, who complains that the cast feels as if it's getting tighter A 56-year-old male, who had an arthroscopy of his left knee 3 hours ago, who is asking to be discharged A 60-year-old female, who is in traction to manage chronic muscle spasms, who is requesting assistance to order her evening meal The order doesn't matter; all clients are of equal priority

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation?

Abduction Adduction Flexion Internal rotation

What is the best action by the nurse to achieve optimal outcomes when caring for a client with a musculoskeletal disorder who is using a cast?

Educate the client on cast care and complications Prepare the client for cast application Assess for neurovascular compromise Provide effective pain control

The health care provider is preparing to bivalve the client's cast. Which supplies should the nurse assemble?

Elastic compression bandages Gauze bandages and tape Sterile saline and basin Stockinette and cotton padding

The nurse teaching the client with a cast about home care includes which instruction?

Cover the cast with plastic or rubber Keep the cast below heart level Fix a broken cast by applying tape Dry a wet fiberglass cast thoroughly to avoid skin problems

Which would be consistent as a component of self-care activities for the client with a cast?

Cover the cast with plastic to insulate it Cushion rough edges of the cast with tape Frequently place the casted extremity in a dependent position Use a plastic hanger wrapped in gauze to scratch under the cast.

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 Cushioning rough edges of the cast with tape Elevate the casted extremity to heart level frequently Do not attempt to scratch the skin under a cast

The nurse is assisting with the application of a cast. What will the nurse expect to be done first?

Covering the skin with a stockinette. Applying strips of the cast material evenly. Arranging for an x-ray to check bone alignment. Cleaning the skin surface.

A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do?

Cut a cast window. Remove the cast. Apply a fiberglass cast. Initiate physical therapy.

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 Re-fracture of the hip Contracture of the hip Avascular necrosis of the hip

An unresponsive client had a plaster cast applied to the right lower leg 8 hours ago. When moving the client, the nurse notices an indentation on the posterior lower portion of the cast. What is the best action by the nurse?

Document the findings. Notify the physician. Remove the cast immediately. Assess for pedal pulse and mobility of toes.

A patient has a long leg cast applied. Where does the nurse understand a common pressure problem may occur?

Dorsalis pedis Peroneal nerve Popliteal artery Posterior tibialis

The nurse is caring for a client who had a total knee replacement 3 days ago. Which nursing assessment finding requires immediate attention by the nurse?

Drainage from wound suction device = 100 ml Previous shift urine output = 500 ml Crackles that clear with coughing Hypoactive bowel sounds

The nurse has identified the diagnosis of Risk for Impaired Tissue Perfusion Related to Deep Vein Thrombosis in the care of a client receiving skeletal traction. What nursing intervention best addresses this risk?

Encourage independence with ADLs whenever possible. Monitor the client's nutritional status closely. Teach the client to perform ankle and foot exercises within the limitations of traction. Administer clopidogrel as prescribed.

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

Keep the cast clean and dry. Position the client on the affected side. Promote elimination with a regular bedpan. Keep the legs in abduction.

A nurse is caring for a patient who is postoperative day 1 right hip replacement. How should the nurse position the patient?

Keep the client's hips in abduction at all times. Keep hips flexed at no less than 90 degrees. Elevate the head of the bed to high Fowler's. Seat the client in a low chair as soon as possible.

The nurse suspects that a client with an arm cast has developed a pressure ulcer. Where should the nurse assess for the presence of the ulcer?

Lateral malleolus Olecranon Radial styloid Ulna styloid

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 arthroplasty Left hip arthroscopy Open reduction and internal fixation of the left hip. Closed reduction of the left hip.

A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period?

Neuroma Hematoma Chronic osteomyelitis Unexplainable burning pain (causalgia)

A client broke his arm in a sports accident and required the application of a cast. Shortly following application, the client reported an inability to straighten his fingers and was subsequently diagnosed with Volkmann contracture. What pathophysiologic process caused this complication?

Obstructed arterial blood flow to the forearm and hand Simultaneous pressure on the ulnar and radial nerves Irritation of Merkel cells in the client's skin surfaces Uncontrolled muscle spasms in the client's forearm

A client is reporting pain in her casted leg. The nurse has administered analgesics and elevated the limb. Thirty minutes after administering the analgesics, the client states the pain is unrelieved. The nurse should identify the warning signs of what complication?

Subcutaneous emphysema Skin breakdown Compartment syndrome Disuse syndrome

A client has suffered a muscle strain and is reporting pain at 6 on a 10-point scale. The nurse should recommend what action?

Taking an opioid analgesic as prescribed Applying a cold pack to the injured site Performing passive ROM exercises Applying a heating pad to the affected muscle

After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do?

Tell the client that this noncompliance will be reported to the health care provider. Discuss the complications that the client may experience if there is lack of cooperation with the care plan. Do nothing because the client has the ultimate right to determine the degree of participation. Document the client's refusal to ambulate.

Which is not a guideline for avoiding hip dislocation after replacement surgery.

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. Keep the knees apart at all times. Put a pillow between the legs when sleeping. Never cross the legs when seated.

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed?

The leg will look as it did prior to the cast being applied. The leg will look moist and will have small bumps that will go away in a few days. The skin may be covered with a yellowish crust that will shed in a few days. The leg strength is enforced by the wearing of the cast.

Which statement describes external fixation?

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. 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 restored to its normal position by external manipulation. The bone is surgically exposed and realigned.

Which is an inaccurate principle of traction?

The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely. The client must be in good alignment in the center of the bed. Skeletal traction is interrupted to turn and reposition the client.

A client has just begun been receiving skeletal traction and the nurse is aware that muscles in the client's affected limb are spastic. How does this change in muscle tone affect the client's traction prescription?

Traction must temporarily be aligned in a slightly different direction. Extra weight is needed initially to keep the limb in proper alignment. A lighter weight should be initially used. Weight will temporarily alternate between heavier and lighter weights.

A client 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?

Use of a cardiopulmonary bypass machine Postoperative blood salvage Prophylactic blood transfusion Autologous blood donation

Arthrodesis is:

fusion of a joint (most often the wrist or knee) for stabilization and pain relief. total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain. replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. cutting and removal of a wedge of bone (most often the tibia or femur) to change the bone's alignment, thereby improving function and relieving pain.

Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure?

Fasciotomy Osteotomy Arthroplasty Arthrodesis

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse?

Assess for complications. Assess for previous opioid drug use. Reposition the client for comfort. Teach relaxation techniques.

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene?

Body aligned opposite to line of traction pull Weights hanging and touching the floor Pulleys without evidence of the obstruction Ropes freely moving over pulleys

A nurse is caring for an older adult client who is preparing for discharge following recovery from a total hip replacement. What outcome must be met prior to discharge?

Client is able to perform ADLs independently. Client is able to perform transfers safely. Client is able to weight-bear equally on both legs. Client is able to demonstrate full ROM of the affected hip.

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

Ease the client onto a low toilet seat. Allow the client's legs to be crossed at the knees when out of bed. Use soft chairs when the client is sitting out of bed. Limit hip flexion of the client's hip when the client sits up.

A nurse is caring for a client after stabilization of a radial fracture. Which actions by the nurse would be appropriate for the client following arm casting? Select all that apply.

Elevate the arm on a plastic-covered pillow Protect the cast by covering with a sheet Handle the cast with the palms of hands Circulate room air with a portable fan Petal and smooth the edges of the cast

An elderly client's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment?

The presence of leg shortening The client's complaints of pain Signs of neurovascular compromise The presence of internal or external rotation

A client was brought to the emergency department after a fall. The client is taken to the operating room to receive a right hip prosthesis. In the immediate postoperative period, what health education should the nurse emphasize?

"Make sure you don't bring your knees close together." "Try to lie as still as possible for the first few days." "Try to avoid bending your knees until next week." "Keep your legs higher than your chest whenever you can."

The client with a newly applied cast reports severe unrelenting pain. What is the nurse's best response?

Make the client NPO and notify the health care provider. Loosen the edges of the cast and elevate the leg. Reposition the extremity for comfort and apply heat. Administer a dose of morphine sulfate.

An older female client who had a total hip replacement is to be discharged because her healing is almost complete. What would be most important for this client?

Advising the client to avoid red meat. Urging her to keep the affected limb in an elevated position. Educating the client about the effects of menopause. Exploring factors related to the client's home environment.

The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery?

Antidysrhythmic therapy Antianginal therapy Antineoplastic therapy Anticoagulation therapy

Which would be an inappropriate initial pain relief measure for the client with a cast?

Application of cold packs Application of a new cast Administration of analgesics Elevation of the involved part

Which intervention would the nurse implement with the client in skeletal traction? Select all that apply.

Apply 8-pound weight to the rope. Ensure the pins or wires are covered with caps. Remove foam boot and inspect skin daily. Position trapeze within the client's reach. Instruct the client on isometric exercises for immobilized extremity.

A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?

Better molding to the client Quicker drying Longer lasting More breathable

A nurse is caring for a client in skeletal leg traction. Which nursing assessment findings indicate the client has met expected outcomes? Select all that apply.

Capillary refill less than 3 seconds Repositions self with trapeze Peripheral pulses +2 bilaterally Right calf warm and swollen Elbows are free of skin breakdown