Chapter 42 Prepu

Which of the following type of fracture is associated with osteoporosis?

Compression Stress Oblique Simple

A patient falls while skiing and sustains a supracondylar fracture. What does the nurse know is the most serious complication of a supracondylar fracture of the humerus?

Hemarthrosis Paresthesia Malunion Volkmann's ischemic contracture

A client who has suffered a compound fracture is preparing for discharge to home. During the teaching session, the client asks why he needs antibiotics for a broken bone. Which response by the nurse is most appropriate?

"Antibiotic therapy has been prescribed as a precaution because your bone was exposed to the environment at the time of your injury." "You may discuss your prescriptions with your physician at your follow-up appointment." "If your temperature is normal for 48 hours, you may discontinue the medication." "The antibiotics will help the bone to heal."

A client undergoes a total hip replacement. Which statement made by the client indicates 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 don't know if I'll be able to get off that low toilet seat at home by myself."

A client is transported to the emergency department for a femur fracture following a motor vehicle crash. What action by the nurse is the highest priority?

Assess vital signs and level of consciousness. Administer pain medication per orders. Assess pedal pulses. Assess the diameter of the thigh every 15 minutes.

If a dislocation is not treated promptly, tissue death due to anoxia can occur. This would be documented as which of the following?

Avascular necrosis (AVN) Subluxation Heterotopic ossification Osteomyelitis

Colles fracture occurs in which area?

Elbow Humeral shaft Clavicle Distal radius

A client has delayed bone healing in a fractured right humerus. What should the nurse prepare the client for that promotes bone growth?

Electrical stimulation Administration of low-dose heparin Joint fusion Administration of antibiotics

A young client is being treated for a femoral fracture suffered in a snowboarding accident. The nurse's most recent assessment reveals that the client is uncharacteristically confused. What diagnostic test should be performed on this client?

Electrolyte assessment Electrocardiogram Arterial blood gases Abdominal ultrasound

Which general nursing measure is used for a client with a fracture reduction?

Encourage participation in ADLs Promote intake of omega-3 fatty acids Examine the abdomen for enlarged liver or spleen Assist with intake of immune-enhancing tube feeding formulas

The orthopedic nurse should assess for signs and symptoms of Volkmann contracture if a client has fractured which of the following bones?

Femur Humerus Radial head Clavicle

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

Imbalanced nutrition: Less than body requirements related to immobility Impaired physical mobility related to trauma Infection related to effects of trauma Activity intolerance related to weight-bearing limitations

A client is being treated for a fractured hip and the nurse is aware of the need to implement interventions to prevent muscle wasting and other complications of immobility. What intervention best addresses the client's need for exercise?

Performing gentle leg lifts with both legs Performing massage to stimulate circulation Encouraging frequent use of the over-bed trapeze Encouraging the client to logroll side to side once per hour

A nurse is caring for a client who has suffered an unstable thoracolumbar fracture. What goal should the nurse prioritize during nursing care?

Preventing skin breakdown Maintaining spinal alignment Maximizing function Preventing increased intracranial pressure

A nurse is inspecting the area of contusion and notes numerous areas of bruising. How would the nurse document this finding?

Whiplash injury Callus Ecchymosis Palsy

Which may occur if a client experiences compartment syndrome in an upper extremity?

Whiplash injury Volkmann's contracture Callus Subluxation

Elderly clients who fall are most at risk for which injuries?

Wrist fractures Humerus fractures Pelvic fractures Cervical spine fractures

There are a variety of problems that can become complications after a fracture. Which is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head?

avascular necrosis fat embolism pulmonary embolism shock

A client has a fractured femur and is being seen in the emergency department. The nurse assessing the area notices there is a grating sound that is suspected to be bone ends moving over one another. This would be called:

crepitus. false motion. spasm. deformity.

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. During postoperative recovery, what specific complication might develop in this client's case?

compartment syndrome subluxation pyelonephritis All options are correct.

A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose?

contusion sprain strain subluxation

The type of fracture described as having one side of the bone broken and the other side bent would be:

greenstick. oblique. spiral. transverse.

A client has been in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma?

immobilization surgical repair external rotation enhancing complications

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

joint manipulation and immobilization analgesia and immobilization heat and immobilization ice and immobilization

A client who plays tennis is experiencing elbow discomfort. Following assessment, the client receives a diagnosis of tendinitis, epicondylitis, or tennis elbow. What symptoms and signs did the client have? Select all that apply.

pain radiating down the dorsal surface of the forearm weak grasp pain or burning in one or both hands pain more prominent at night

A fracture is considered pathologic when it

results in a fragment of bone being pulled away by a ligament or tendon and its attachment. occurs through an area of diseased bone. involves damage to the skin or mucous membranes. presents as one side of the bone being broken and the other side being bent.

With fractures of the femoral neck, the leg is

shortened, adducted, and externally rotated. shortened, abducted, and internally rotated. adducted and internally rotated. abducted and externally rotated.

A client who was injured while playing basketball reports an extremely painful elbow, which is very edematous. What type of injury has the client experienced?

sprain strain contusion All options are correct.

A school nurse is assessing a student who was kicked in the shin during a soccer game. The area of the injury has become swollen and discolored. The triage nurse should organize care for a:

sprain. strain. contusion. dislocation.

Which nursing intervention is appropriate for monitoring the client for the development of Volkmann's contracture?

Assess capillary refill in the toes. Assess for paresthesia in the toes. Assess the radial pulse. Assess mobility of the shoulder.

The nurse is required to design a teaching plan for a client with a ruptured Achilles tendon. What education will the nurse provide?

Dietary restrictions Activity restrictions Use of nonprescription medications Effective pin care

In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor in the client?

Disseminated intravascular coagulation Compartment syndrome Carpal tunnel syndrome Fat embolism syndrome

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse?

"Your left toes have been amputated." "The pain is really from the nerves in the upper leg." "Pain medication usually does not help this type of pain." "Describe the pain and rate it on the pain scale."

A client sprains an ankle while playing tennis and is brought to the emergency department. What is the priority action by the nurse?

Heat, compression, analgesics, and exercise Rest, heat, compression, and elevation Rest, ice, compression, and elevation Exercise, ice, compression, and elevation

A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient?

Hypovolemic shock Infection Knee and hip dislocation Pain resulting from muscle spasm

A patient sustains an open fracture with extensive soft tissue damage. The nurse determines that this fracture would be classified as what grade?

I II III IV

The nurse is teaching the client who will undergo surgery for a transverse fracture. Which image best depicts this type of fracture?

Pictures on word doc A B C D

A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications? Select all that apply.

Pneumonia Necrosis of the humerus Skin breakdown Sepsis Delirium

An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as?

Volkmann's contracture Subluxation Compartment syndrome Sprain

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

With the affected hip flexed acutely With the leg on the affected side abducted With the leg on the affected side adducted With the affected hip rotated externally

A professional tennis player comes to the orthopedic clinic and informs the nurse that he is having pain that radiates down the forearm and is unable to grasp the racket firmly. What does the nurse suspect is occurring with the client?

Carpal tunnel syndrome Ganglion cyst Epicondylitis Shoulder dislocation

Which type of fracture produces several bone fragments?

Comminuted Open Oblique Incomplete

An older adult client experienced a fall and required treatment for a fractured hip on the orthopedic unit. Which of the following are contributory factors to the incidence of falls and fractured hips among the older adult population? Select all that apply.

Loss of visual acuity Adverse medication effects Slowed reflexes Hearing loss Muscle weakness

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

Provide wound care without discussing the amputation. Request a referral to occupational therapy. Encourage the client to perform range-of-motion (ROM) exercises to the right leg. Provide feedback on the client's strengths and available resources.

A nurse is planning the care of an older adult client who will soon be discharged home after treatment for a fractured hip. In an effort to prevent future fractures, the nurse should encourage what actions? Select all that apply.

Regular bone density testing A high-calcium diet Use of falls prevention precautions Use of corticosteroids as prescribed Weight-bearing exercise

Many orthopedic-related injuries occur while participating in sports or in the workplace. Which elements would be included in client and family teaching aiming at prevention?

All options are correct. Use proper equipment at work and during participation in athletic activities. At work, look at ways to modify the environment to prevent injury. Exercise regularly to maintain joint and muscle strength.

The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury?

Cardiogenic Hypovolemic Neurogenic Septic

The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture should be included? (Select all that apply.)

Checking the urine for hematuria Palpating peripheral pulses in both lower extremities Testing the stool for occult blood Assessing level of consciousness Assessing pupillary response

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for:

Crepitus. Shortening and deformity. Capillary refill. Swelling and discoloration.

Which term refers to the failure of fragments of a fractured bone to heal together?

Dislocation Subluxation Nonunion Malunion

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

"Apply ice packs for the first 12 to 18 hours." "Apply heat packs for the first 24 to 48 hours." "Apply ice packs for the first 24 to 48 hours, then apply heat packs." "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours."

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care?

"Cover the cast with a blanket until the cast dries." "Keep your right leg elevated above heart level." "Use a knitting needle to scratch itches inside the cast." "A foul smell from the cast is normal."

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

"Elevating the leg might lead to a flexion contracture." "You need to turn yourself side to side. If your leg is on a pillow, you would not be able to do that." "Elevating the extremity may increase your chances of compartment syndrome." "I am sorry. We ran out of pillows. I can elevate it on a few blankets."

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching?

"I'll start with ice for the first couple of hours and then apply heat." "I need to stay off my ankle for at least the next 3 to 4 weeks." "I'll get the prescription filled for the narcotic pain reliever." "I'll make sure to keep my ankle elevated as much as possible."

A 14-year-old client is treated in the emergency room for an acute knee sprain sustained during a soccer game. The nurse reviews discharge instructions with the client's parent. The nurse instructs the parent that the acute inflammatory stage will last how long?

24 to 48 hours 3 to 4 days 4 to 5 days At least 7 days

The nurse advises a 36-year-old patient who suffered a severe wrist sprain subsequent to a fall that she can begin progressive passive and active exercises in:

24 to 48 hours. 3 to 5 days. 1 to 3 weeks. 1 month.

The nurse is caring for a patient after arthroscopic surgery for a rotator cuff tear. The nurse informs the patient that full activity can usually resume after what period of time?

3 to 4 weeks 8 weeks 3 to 4 months 6 to 12 months

A client has returned to the postsurgical unit from the PACU after an above-the-knee amputation of the right leg. Results of the nurse's initial postsurgical assessment were unremarkable but the client has called out. The nurse enters the room and observes copious quantities of blood at the surgical site. What should be the nurse's initial action?

Apply a tourniquet. Elevate the residual limb. Apply sterile gauze. Call the surgeon.

The primary nursing intervention that will control swelling while treating a musculoskeletal injury is:

Apply cold (moist or dry). Immobilize the injured area. Elevate the affected area. Apply an elastic compression bandage.

A nurse is performing a shift assessment on an elderly client who is recovering after surgery for a hip fracture. The client reports chest pain, has an increased heart rate, and increased respiratory rate. The nurse further notes that the client is febrile and hypoxic, coughing, and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this client is likely demonstrating symptoms of what complication?

Avascular necrosis of bone Compartment syndrome Fat embolism syndrome Complex regional pain syndrome

A client with a fracture develops compartment syndrome that requires surgical intervention. What treatment will the nurse would most likely prepare the client for?

Bone graft Joint replacement Fasciotomy Amputation

A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states that he cannot feel or move his fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures?

Compartment syndrome Dislocation Muscle spasms Subluxation

Which term refers to a blunt force injury to soft tissue?

Contusion Dislocation Strain Fracture

Which of the following is a term used to describe a soft tissue injury produced by a blunt force?

Contusion Sprain Strain Hematoma

Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia?

Disseminated intravascular coagulation (DIC) Avascular necrosis (AVN) Complex regional pain syndrome (CRPS) Fat embolism syndrome (FES)

When is it advisable for the nurse to apply heat to a sprain or a contusion?

Do not apply at all Immediately After 2 days Only after a week

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

Do not flex the hip more than 30 degrees. Do not flex the hip more than 60 degrees. Do not flex the hip more than 90 degrees. Do not flex the hip more than 120 degrees.

Which nursing diagnosis is the most appropriate for a client with a strained ankle?

Impaired skin integrity Impaired physical mobility Risk for deficient fluid volume Disturbed body image

Which nursing intervention is essential in caring for a client with compartment syndrome?

Keeping the affected extremity below the level of the heart Wrapping the affected extremity with a compression dressing to help decrease the swelling Removing all external sources of pressure, such as clothing and jewelry Starting an I.V. line in the affected extremity in anticipation of venogram studies

An emergency department nurse is assessing a 17-year-old soccer player who presented with a knee injury. The client's description of the injury indicates that his knee was struck medially while his foot was on the ground. The nurse knows that the client likely has experienced what injury?

Lateral collateral ligament injury Medial collateral ligament injury Anterior cruciate ligament injury Posterior cruciate ligament injury

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

Less than 24 hours Between 24 and 48 hours About 72 hours At least 1 week

A client who was in a motor vehicle crash is diagnosed with a stable T7 spinal fracture with no neurologic deficits. Which nursing intervention should the nurse implement?

Maintain bed rest with the head of the bed at 20 degrees. Withhold opioid pain medication to prevent ileus. Maintain NPO (nothing by mouth) status for surgical repair. Sit the client upright in a padded chair for meals.

The emergency department nurse teaches clients with sports injuries to remember the acronym PRICE. This acronym stands for which combination of treatments?

Protection, rest, ice, circulation, examination Pressure, rotation, immersion, compression, elevation Protection, rest, ice, compression, elevation Pressure, rotation, ice, compression, examination

The RICE acronym is helpful for remembering treatment interventions for musculoskeletal injuries. Which of the following are components of the RICE acronym? Select all that apply.

Rest Ice Compression Elevation Edema Corticosteroids

A nurse is writing a care plan for a client admitted to the emergency department (ED) with an open fracture. The nurse will assign priority to what nursing diagnosis for a client with an open fracture of the radius?

Risk for Infection Risk for Ineffective Role Performance Risk for Perioperative Positioning Injury Risk for Powerlessness

What assessment findings of the leg are consistent with a fracture of the femoral neck?

Shortened, adducted, and externally rotated Shortened, abducted, and internally rotated Adducted and internally rotated Abducted and externally rotated

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

Spiral Greenstick Avulsion Oblique

A client reports pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The client was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury?

Sprain Dislocation Subluxation Strain

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

Sprain Dislocation Subluxation Strain

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

Strain Contusion Sprain Fracture

A client is brought to the emergency department by ambulance after stepping in a hole and falling. While assessing him the nurse notes that his right leg is shorter than his left leg; his right hip is noticeably deformed and he is in acute pain. Imaging does not reveal a fracture. What is the most plausible explanation for this client's signs and symptoms?

Subluxated right hip Right hip contusion Hip strain Traumatic hip dislocation

A client is diagnosed with a first-degree strain of the left ankle related to running 5 miles daily. How would the nurse differentiate the first-degree strain from other strains and sprains?

The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices. The client is unable to bear weight on the left ankle and has a large ecchymotic area. The client has ecchymosis, edema, and has no function of the left foot and ankle. The client complains of pain when the joint is moved and has mild edema.

A client who has fallen and injured a hip cannot place weight on the leg and is in significant pain. After radiographs indicate intact but malpositioned bones, what would the physician diagnose?

dislocation strain sprain fracture

A client is experiencing pain, joint instability, and difficulty walking due to an injury to the knee ligaments. The injury was judged not to require surgery. Which intervention would not be included in this client's care?

traction joint immobilization limited weight bearing ice and NSAIDs

A client is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The client has been placed in traction until his femur can be rodded in surgery. For what early complications should the nurse monitor this client? Select all that apply.

Systemic infection Complex regional pain syndrome Deep vein thrombosis Compartment syndrome Fat embolism

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

Administer medication, as ordered, for the reported discomfort. Contact the health care provider. Initiate a consult with a psychologist. Do nothing because it isn't possible to have pain in a missing limb.

A nurse is preparing to discharge a client from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage what action?

Apply heat for the first 24 to 48 hours after the injury. Maintain the ankle in a dependent position. Exercise hourly by performing rotation exercises of the ankle. Keep an elastic compression bandage on the ankle.

A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin?

As soon as tolerated, after a reasonable period of immobilization In 2 to 3 weeks, when callus ossification prevents easy movements of bony fragments In about 4 to 5 weeks, after new bone is well established In 2 to 3 months, after normal activities are resumed

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention?

Compound Greenstick Oblique Spiral

A classic indicator of edema and alveolar hemorrhage associated with FES is:

Tachycardia. Hyperventilation. Crackles and wheezes. Tachypnea.

A client comes to the clinic 2 days after sustaining a sprain to the left ankle. What intervention can the nurse encourage the client to perform that will help improve circulation?

Active range-of-motion exercises Take nonsteroidal anti-inflammatory drugs Applying cold compresses Applying heat

Which assessment findings would the nurse expect to find in the postoperative client experiencing fat embolism syndrome?

Column A Column B Column C Column D

The client scheduled for a Syme amputation is concerned about the ability to eventually stand on the amputated extremity. How should the nurse best respond to the client's concern?

"You will eventually be able to withstand full weight-bearing after the amputation." "You will have minimal weight-bearing on this extremity but you'll be taught how to use an assistive device." "You likely will not be able to use this extremity but you will receive teaching on use of a wheelchair." "You will be fitted for a prosthesis which may or may not allow you to walk."

The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication?

Compartment syndrome Hypovolemic shock Fat embolism syndrome Reflex sympathetic dystrophy syndrome

A client who has extremity right wrist fracture complains of severe burning pain, frequent changes in the skin from hot and dry to cold, and feeling clammy skin that is shiny and growing more hair in the injured extremity. The nurse should anticipate providing care for what complication?

Complex regional pain syndrome Avascular necrosis of bone Reaction to an internal fixation device Heterotrophic ossification

A client was climbing a ladder, slipped on a rung, and fell on the right side of the chest. X-ray studies reveal three rib fractures, and the client reports pain with inspiration. What is the anticipated treatment for this client?

Chest strapping Mechanical ventilation Coughing and deep breathing with pillow splinting Thoracentesis

Six weeks after an above-the-knee amputation (AKA), a client returns to the outpatient office for a routine postoperative checkup. During the nurse's assessment, the client reports symptoms of phantom pain. What should the nurse tell the client to do to reduce the discomfort of the phantom pain?

Apply intermittent hot compresses to the area of the amputation. Avoid activity until the pain subsides. Take opioid analgesics as prescribed. Elevate the level of the amputation site.

The client has suffered a comminuted fracture. Which image best depicts this type of fracture?

Photos on Word doc A B C D

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

"I cannot seem to catch my breath." "I have a pins-and-needles sensation in my toes." Dorsoplantar weak and unequal bilaterally T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90% Both feet warm with capillary refill < 3 seconds

A nurse is caring for a client who has sustained ligament and a meniscal injury to the knee. Which action would be most appropriate to allow the client to progress without causing further injury?

Administer nonsteroidal anti-inflammatory drugs (NSAIDs) regularly. Apply heat to the affected area every night. Apply a cold pack to the affected area every night. Assist with a gradual introduction of activity.

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain?

Administer prescribed analgesics around-the-clock. Avoid administering too much medication because the client is older. Administer prescribed pain medication only when the client requests it. Give pain medication to the client after providing care.

Emergency medical technicians transport a client to the emergency department and inform the nurse that the client fell from a two-story building. The comatose client has a large contusion on the left side of the chest, a hematoma in the left parietal area, and a compound fracture of the left femur. The client was intubated and is maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse has the highest priority?

Assessing the left leg Assessing the pupils Placing the client in Trendelenburg's position Assessing level of consciousness (LOC)

A nurse is caring for a client who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the client does what action to prevent common complications associated with a hip fracture?

Avoid requesting analgesia unless pain becomes unbearable. Use supplementary oxygen when transferring or mobilizing. Increase fluid intake and perform prescribed foot exercises. Remain on bed rest for 14 days or until instructed by the orthopedic surgeon.

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?

Comminuted Compression Impacted Greenstick

A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and observes petechiae on the client's chest. Which nursing action is indicated first?

Elevate the affected extremity. Contact the nursing supervisor. Administer oxygen. Contact the health care provider.

A client is brought in by ambulance to the emergency department after being involved in a motorcycle accident. The client has an open fracture on his tibia. The wound is highly contaminated and there is extensive soft- tissue damage. How would this client's fracture likely be graded?

Grade I Grade II Grade III Grade IV

Which factor may contribute to compartment syndrome?

Hemorrhage Macular lesion Venous thromboembolus Disuse syndrome

Radiographs of a boy's upper arm show that the humerus appears to be fractured on one side and slightly bent on the other. This diagnostic result suggests what type of fracture?

Impacted Compound Compression Greenstick

Which type of fracture occurs when a bone fragment is driven into another bone fragment?

Impacted Oblique Spiral Transverse

A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall?

Impacted fracture Transverse fracture Compound fracture Pathologic fracture

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

Keep the affected leg in a position of adduction. Use measures other than turning to prevent pressure ulcers. Prevent internal rotation of the affected leg. Keep the hip flexed by placing pillows under the client's knee.

A client who has had an amputation is being cared for by a multidisciplinary rehabilitation team. What is the primary goal of this multidisciplinary team?

Maximize the efficiency of care Ensure that the client's health care is holistic Facilitate the client's adjustment to a new body image Promote the client's highest possible level of function

Which is a hallmark sign of compartment syndrome?

Motor weakness Edema Pain Weeping skin surfaces

Which is one of the most common causes of death in clients diagnosed with fat emboli syndrome?

Myocardial infarction Stroke Acute respiratory distress syndrome Pulmonary embolism

A client has been diagnosed with a rotator cuff tear. What are the options for treating this condition? Select all that apply.

NSAIDs activity modification and joint rest arthroscopic surgery traction

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment?

Nonunion Delayed union Malunion Subluxation

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

Performing passive range-of-motion (ROM) exercises on the client's legs once each shift Keeping a pillow between the client's legs at all times Turning the client from side to side every 2 hours Maintaining the client in semi-Fowler's position

A nurse is caring for a construction worker who fell from the second story of a building site and fractured the femoral neck. Which nursing diagnosis is a priority for the client? Select all that apply.

Risk for infection Impaired physical mobility Risk for injury Urinary incontinence Disturbed body image

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain?

Rotator cuff tears Epicondylitis Heterotopic ossification Acute compartment syndrome

A client arrives in the emergency room complaining of severe pain in her left hip after falling out of the bed. What indication upon assessment does the nurse recognize as a dislocated left hip? Select all that apply.

The left leg is shorter than the right. Limited range of motion of the left hip. The skin over the left hip is warm. The skin of the lower left leg is pale. The client is able to bend the knee but not move toes.

Which of the following are associated with compartment syndrome? Select all that apply.

Trauma from accidents Surgery Casts Tight bandages Crushing injuries

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

cranial nerve assessment administering analgesics providing comfort measures assisting with ADLs

When the client who has experienced trauma to an extremity reports severe burning pain, vasomotor changes, and muscles spasms in the injured extremity, the nurse recognizes that the client is likely

demonstrating signs of complex regional pain syndrome. avascular necrosis of bone. a reaction to an internal fixation device. heterotrophic ossification.

An x-ray demonstrates a fracture in which the fragments of bone are driven inward. This type of fracture is referred to as

depressed. compound. comminuted. impacted.

A nurse is developing a teaching plan for a client who must undergo an above-the-knee amputation of the left leg. After a leg amputation, exercise of the remaining limb:

isn't necessary. should begin immediately postoperatively. should begin the day after surgery. begins at a rehabilitation center.

A nurse's assessment of a client's knee reveals edema, tenderness, muscle spasms, and ecchymosis. The client states that 2 days ago he ran in a long-distance race and now it "really hurts to stand up." The nurse should plan care based on the belief that the client has experienced what?

A first-degree strain A second-degree strain A first-degree sprain A second-degree sprain

The surgical nurse is admitting a client from postanesthetic recovery following the client's below-the-knee amputation. The nurse recognizes the client's high risk for postoperative hemorrhage and should keep what equipment at the bedside?

A tourniquet A syringe preloaded with vitamin K A unit of packed red blood cells, placed on ice A dose of protamine sulfate

A client has sustained a long bone fracture and the nurse is preparing the client's care plan. Which of the following should the nurse include in the care plan?

Administer vitamin D and calcium supplements as prescribed. Monitor temperature and pulses of the affected extremity. Perform passive range of motion exercises as tolerated. Administer corticosteroids as prescribed.

A client has been involved in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. Other than the bone, what physical structures could be affected by this injury?

All options are correct. muscles nerves blood vessels

A client presents at an ambulatory clinic and reports pain and aching in the lower left leg. After examining the client, a health care provider determines the client has experienced a strain related to the client's exercise regimen. The treatment plan includes analgesics, rest, and cold and heat therapies. Which guideline should be included in the care plan?

Alternate heat and cold applications to the extremity continuously. Begin physical training for 30 minutes, gradually increasing to 45 minutes over the next several days. After 24 hours, apply heat for periods of 15 to 30 minutes. Apply cold packs to extremity continuously for the first 48 hours.

A client was playing softball and was hit in the right ankle by the ball sustaining a contusion. What is the first action taken to help alleviate pain and swelling?

Apply heat to the ankle. Apply a cold pack to the ankle. Administer ibuprofen (Advil). Ask the client to walk to stretch the ligaments.

When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction?

Apply heat to the fracture site. Apply ice to the fracture site. Perform ankle dorsiflexion three times per day. Use crutches for 1 week.

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing:

Complex regional pain syndrome Delayed union Compartment syndrome Fat embolism syndrome

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

Elevate the arm above the shoulder three to four times daily. Avoid moving the elbow, wrist, and fingers until bone remodeling is complete. Engage in active range of motion using the affected arm. Use the arm for light activities within the range of motion.

A bone graft may be used for which of the following reasons? Select all that apply.

Joint stabilization Defect filling Stimulation of bone healing Improvement of motion Reduction of a fracture

When caring for a client with a fracture, what assessment would take priority?

Neurovascular compromise Hormonal imbalances Cardiac problems Altered kidney function

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply.

skin breakdown wound infection pneumonia diarrhea

A client has been diagnosed with a muscle strain. What does the physician mean with the term "strain"?

stretched or pulled beyond its capacity injury resulting from a blow or blunt trauma injuries to ligaments surrounding a joint subluxation of a joint

A client sustains an injury to the left ankle when he fell down three steps. There was immediate swelling and pain from the injury, and the client was taken to the local emergency department. What initial test does the nurse anticipate the physician will order to rule out a fracture?

Arthrography Arthroscopy X-ray Computerized tomography (CT scan)

A nurse admits a client who has a fracture of the nose that has resulted in a skin tear and involvement of the mucous membranes of the nasal passages. The orthopedic nurse should plan to care for what type of fracture?

Compression Compound Impacted Transverse

The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the:

Condylar area. Femoral neck. Shaft of the femur. Trochanteric region.

A patient sustains an open fracture of the left arm after an accident at the roller skating rink. What does emergency management of this fracture involve? (Select all that apply.)

Covering the area with a clean dressing if the fracture is open Immobilizing the affected site Splinting the injured limb Asking the patient if he or she is able to move the arm Wrapping the arm in an ace bandage

The nurse is assessing a client's knee. The area has a grating sensation. What would this be documented as?

Crepitus Shortening False motion Dislocation

A client with a simple arm fracture is receiving discharge education from the nurse. What would the nurse instruct the client to do?

Elevate the affected extremity to shoulder level when at rest. Engage in exercises that strengthen the unaffected muscles. Apply topical anesthetics to accessible skin surfaces as needed. Avoid using analgesics so that further damage is not masked.

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?

Elevating the stump for the first 24 hours Maintaining the client on complete bed rest Applying heat to the stump as the client desires Removing the pressure dressing after the first 8 hours

Which nursing diagnosis is a priority for a client with a traumatically amputated lower extremity?

Impaired skin integrity related to effects of the injury Anticipatory grieving related to the loss of a limb Disturbed body image related to changes in the structure of a body part Risk for injury related to amputation

A client has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing his ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have contributed to this complication?

Inadequate vitamin D intake Bleeding at the injury site Inadequate immobilization Venous thromboembolism (VTE)

Which type of fracture involves a break through only part of the cross-section of the bone?

Incomplete Comminuted Open Oblique

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

Increased ability to stretch arm over the head Difficulty lying on affected side Pain worse in the morning Minimal pain with movement

Which factor inhibits fracture healing?

Increased vitamin D and calcium in the diet Age of 35 years History of diabetes Immobilization of the fracture

A nurse is planning the care of a client with osteomyelitis that resulted from a diabetic foot ulcer. The client requires a transmetatarsal amputation. When planning the client's postoperative care, which of the following nursing diagnoses should the nurse most likely include in the plan of care?

Ineffective Thermoregulation Risk-Prone Health Behavior Disturbed Body Image Deficient Diversion Activity

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

Infection Malunion Complex regional pain syndrome Depression

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect?

Infection Pulmonary embolism Avascular necrosis Hypovolemic shock

The nurse is providing care for a client who has had a below-the-knee amputation. The nurse enters the client's room and finds the client resting in bed with his residual limb supported on pillow. What is the nurse's most appropriate action?

Inform the surgeon of this finding. Explain the risks of flexion contracture to the client. Transfer the client to a sitting position. Encourage the client to perform active ROM exercises with the residual limb.

A client is to have an amputation. The client is acutely ill and diagnosed with a gangrenous limb and related fever, disorientation, and electrolyte imbalances. Which of the following would be most important for the nurse to monitor in this client?

Signs of sepsis Signs of nausea and vomiting Occurrence of allergic reactions Reduced urine output

A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes the patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse understand is likely occurring with this patient?

Spontaneous pneumothorax Cardiac tamponade Pneumonia Fat emboli

A client who has fractured the radial head asks the nurse about factors that will promote bone healing. Which statement should the nurse include when responding to the client? Select all that apply.

"Immobilization of the fracture will promote healing by maximizing contact of bone fragments." "Fractured bones require a good blood supply and adequate nutrition for healing." "Weight bearing stimulates healing of the long bones of the leg, if the fracture is stabilized." "Adults heal faster than children because adult bodies are physiologically more mature." "Corticosteroids will decrease the bone and soft tissue inflammation associated with the fracture."

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

Ability to stretch arm over the head Difficulty lying on affected side Pain worse in the morning Minimal pain with movement

What nursing intervention should the nurse prioritize to facilitate healing in a client who has suffered a hip fracture?

Administer analgesics as required. Place a pillow between the client's legs when turning. Maintain prone positioning at all times. Encourage internal and external rotation of the affected leg.

The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury?

Cardiogenic Hypovolemic Neurogenic Septicemic

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

Client can demonstrate safe use of assistive devices. Client has a healed, nontender, nonadherent scar. Client can perform activities of daily living independently. Client is free of pain.

A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture?

Closed Incomplete Stress Compression

A client reports to the emergency department after experiencing pain in the left arm. The client reports having extended both arms in an attempt to prevent a fall. Which fracture type does the nurse anticipate?

Colles fracture Spiral fracture Greenstick fracture Compound fracture

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?

Compartment syndrome Fat embolism Infection Volkmann's ischemic contracture

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

Compartment syndrome. Phlebitis. Infection. Chronic venous insufficiency.

Which type of fracture is one in which the skin or mucous membrane wound extends to the fractured bone?

Compound Complete Incomplete Simple

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

Compound Depressed Impacted Comminuted

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

Encourage participation in ADLs Promote intake of omega-3 fatty acids Use frequent dependent positioning to prevent edema Administer prescribed enema to prevent constipation

A nurse is caring for a client who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.)

Encouraging the client to care for the residual limb Allowing the client to express grief Encouraging the client to have family and friends view the residual limb to decrease self-consciousness Encouraging family and friends to refrain from visiting temporarily because this may increase the client's embarrassment Introducing the client to local amputee support groups

A nurse is caring for a client who had a right below-the-knee amputation (BKA). The nurse recognizes the importance of implementing measures that focus on preventing flexion contracture of the hip and maintaining proper positioning. What nursing action will best achieve these goals?

Encouraging the client to turn from side to side and to assume a prone position Initiating ROM exercises of the hip and knee 10 to 12 weeks after the amputation Minimizing movement of the flexor muscles of the hip Encouraging the client to sit in a chair for at least 8 hours a day

A client with a right below-the-knee amputation is being transferred from the postanesthesia care unit to a medical-surgical unit. What is the highest priority nursing intervention by the receiving nurse?

Ensure that a large tourniquet is in the room. Document the receiving report from the transferring nurse. Delegate the gathering of enough pillows for proper positioning and comfort. Review the physician's orders for type and frequency of pain medication.

The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding?

Extension of the fingers of the right hand Nodules on the knuckles of the third and fourth finger Claw-like deformity of the right hand without ability to extend fingers Dislocation of the fingers

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

Fracture Contusion Sprain Strain

A client comes to the emergency department complaining of localized pain and swelling of his lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely?

Fracture Contusion Sprain Strain

In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor?

Gastrointestinal bleeding Compartment syndrome Carpal tunnel syndrome Ganglion cysts

Which term refers to a break in the continuity of a bone?

Malunion Dislocation Fracture Subluxation

A nurse in a busy emergency department provides care for many clients who present with contusions, strains, or sprains. What are treatment modalities that are common to all of these musculoskeletal injuries? Select all that apply.

Massage Applying ice Compression dressings Resting the affected extremity Corticosteroids Elevating the injured limb

A client has presented to the emergency department with an injury to the wrist. The client is diagnosed with a third-degree strain. Why would the health care provider prescribe an x-ray of the wrist?

Nerve damage is associated with third-degree strains. Compartment syndrome is associated with third-degree strains. Avulsion fractures are associated with third-degree strains. Greenstick fractures are associated with third-degree strains.

A client had an above-the-knee amputation of the left leg related to complications from peripheral vascular disease. The nurse enters the client's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse?

Notify the health care provider. Apply a tourniquet. Use skin clips to close the wound. Reinforce the dressing.

An older adult client has fallen in her home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning assessments during the client's presurgical care, the nurse should be aware of the client's heightened risk of what complication?

Osteomyelitis Avascular necrosis Phantom pain Septicemia

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures?

Paresthesia and ischemia Hemorrhage and shock Paralytic ileus and a lacerated urethra Thrombophlebitis and infection

A client is involved in a motorcycle accident and injures his arm. The physician diagnoses the man with an intra-articular fracture and splints the injury. The nurse implements the teaching plan developed for this client. What sequela of intra-articular fractures should the nurse describe regarding this client?

Posttraumatic arthritis Fat embolism syndrome (FES) Osteomyelitis Compartment syndrome

A client was fitted with an arm cast after fracturing her humerus. Twelve hours after the application of the cast, the client tells the nurse that her arm hurts. Analgesics do not relieve the pain. What would be the most appropriate nursing action?

Prepare the client for opening or bivalving of the cast. Obtain a prescription for a different analgesic. Encourage the client to wiggle and move the fingers. Petal the edges of the client's cast.

A teenage client is brought to the clinic by a parent and reports pain in the arm. The client is a member of a high school crew team and practices for 2 ½ hours every day after school. Which of the following would the nurse suspect?

Tendonitis Ganglion Carpal tunnel syndrome Epicondylitis

Which client(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply.

The client with elevated pressure within the muscles The client with hemorrhage in the site of injury The client with a plaster cast applied immediately after injury The client who sustained a clavicle fracture The client using ice to control pain in the extremity

A rehabilitation nurse is working with a client who has had a below-the-knee amputation. In order to determine the client's ability to be an active participant in self-care, the nurse should prioritize assessment of what variable?

The client's attitude The client's learning style The client's nutritional status The client's presurgical level of function

A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?

The fracture line extends through the entire bone substance. The fracture results from an underlying bone disorder. Bone fragments are separated at the fracture line. One side of the bone is broken and the other side is bent.

An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement?

The longer the joint is displaced, the more difficult it is to get it back in place. The client's pain will increase until the joint is realigned. Dislocation can become permanent if the process of bone remodeling begins. Avascular necrosis may develop at the site if it is not promptly resolved.

An elite high school football player has been diagnosed with a shoulder dislocation. The client has been treated and is eager to resume his role on his team, stating that he is not experiencing pain. What should the nurse emphasize during health education?

The need to take analgesia regardless of the short-term absence of pain The importance of adhering to the prescribed treatment and rehabilitation regimen The fact that he has a permanently increased risk of future shoulder dislocations The importance of monitoring for intracapsular bleeding once he resumes playing

Pulselessness, a very late sign of compartment syndrome, may signify

Venous congestion Nerve involvement Diminished arterial perfusion Lack of distal tissue perfusion

Which factor inhibits fracture healing?

Vitamin D Exercise Local malignancy Maximum bone fragment contact