Fractures

3. The client performs isometric exercises to the affected extremity three times per day. Isometric contractions increase the tension within a muscle but do not produce movement. Repeated isometric contractions make muscles grow larger and stronger.

A client has a leg immobilized in traction. Which of the following activities demonstrated by the client indicate that the client understands actions to take to prevent muscle atrophy? 1. The client adducts the affected leg every 2 hours. 2. The client rolls the affected leg away from the body's midline twice per day. 3. The client performs isometric exercises to the affected extremity three times per day. 4. The client asks the nurse to add a 5-lb weight to the traction for 30 minutes/day.

1. Presence of a distal pulse. The nurse should assess the client's ability to move her toes and for the presence of distal pulses, including a neurovascular assessment of the area below the cast.

A client has a tibial fracture that required casting. Approximately 5 hours later, the client has increasing pain distal to the left tibial fracture despite the morphine injection administered 30 minutes previously. Which of the following should be the nurse's next assessment? 1. Presence of a distal pulse. 2. Pain with a pain rating scale. 3. Vital sign changes. 4. Potential for drug tolerance.

1. Review the results of culture and sensitivity testing of the wound. The wound was left open with a three-way drainage system in place to irrigate the debrided wound with normal saline or an antibiotic.

A client returned from surgery with a debrided open tibial fracture and has a three-way drainage system. The nurse should first: 1. Review the results of culture and sensitivity testing of the wound. 2. Look for the presence of a pressure dressing over the wound. 3. Determine if the client has increased pain from exposed nerve endings. 4. Check the client's blood pressure for hypotension resulting from additional vessel bleeding

3. Possible habituating effect. Hypotension, tachycardia, and depressed respirations are signs of high levels of ingestion of muscle relaxants, and the client may be developing a habit of taking this drug for a prolonged period. The potential for abuse should be considered when large doses of a muscle relaxant such as carisoprodol are taken for prolonged periods.

A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted with a blood pressure of 80/50 mm Hg, a pulse rate of 115 bpm, and respirations of 8 breaths/minute and shallow. The nurse interprets these findings as indicating which of the following? 1. Expected common adverse effects. 2. Hypersensitivity reaction. 3. Possible habituating effect. 4. Hemorrhage from gastrointestinal irritation.

4. Dark, scanty urine. The client with compartment syndrome may release myoglobin from damaged muscle cells into the circulation. This becomes trapped in the renal tubules, resulting in dark, scanty urine, possibly leading to acute renal failure.

A client with a fracture develops compartment syndrome. Which of the following signs should alert the nurse to impending organ failure? 1. Crackles. 2. Jaundice. 3. Generalized edema. 4. Dark, scanty urine.

3. Relief of muscle spasms. Methocarbamol is a muscle relaxant and acts primarily to relieve muscle spasms. It has no effect on microorganisms, does not reduce itching, and has no effect on nervousness.

The client with a fractured tibia has been taking methocarbamol (Robaxin). Which of the following indicate that the drug is having the intended effect? 1. Lack of infection. 2. Reduction in itching. 3. Relief of muscle spasms. 4. Decrease in nervousness.

2. Advance a crutch on one side and simultaneously advance and bear weight on the opposite foot; repeat on the opposite side. A two-point gait involves partial weight bearing on each foot, with each crutch advancing simultaneously with the opposing leg.

The nurse prepares a teaching plan for a client about crutch walking using a two-point gait pattern. Which of the following should the nurse include? 1. Advance a crutch on one side and then advance the opposite foot; repeat on the opposite side. 2. Advance a crutch on one side and simultaneously advance and bear weight on the opposite foot; repeat on the opposite side. 3. Advance both crutches together and then follow by lifting both lower extremities to the level of the crutches. 4. Advance both crutches together and then follow by lifting both lower extremities past the level of the crutches.

3. The area distal to the fracture. The nursing assessment is fi rst focused on the region distal to the fracture for neurovascular injury or compromise. When a nerve or blood vessel is severed or obstructed at the actual fracture site, innervation to the nerve or blood flow to the vessel is disrupted below the site; therefore, the area distal to the fracture site is the area of compromised neurologic input or vascular flow and return, not the area above the fracture site or the fracture site itself.

When admitting a client with a fractured extremity, the nurse should first focus the assessment on which of the following? 1. The area proximal to the fracture. 2. The actual fracture site. 3. The area distal to the fracture. 4. The opposite extremity for baseline comparison.

1. The drug can be used if the person is allergic to aspirin. 2. Acetaminophen does not affect platelet aggregation. 3. This drug causes little or no gastric distress. Acetaminophen is an alternative for a client who is allergic to aspirin. It does not affect platelet aggregation and the client does not need to have coagulation studies (such as INR). Acetaminophen causes little or no gastric distress. Acetaminophen exerts no anti-inflammatory effects

When developing a teaching plan for a client who is prescribed acetaminophen (Tylenol) for muscle pain, which information should the nurse expect to include? Select all that apply. 1. The drug can be used if the person is allergic to aspirin. 2. Acetaminophen does not affect platelet aggregation. 3. This drug causes little or no gastric distress. 4. Acetaminophen exerts a strong anti-inflammatory effect. 5. The client should have the International Normalized Ratio (INR) checked regularly

3. "I can pull out cast padding to scratch inside the cast." Clients should not pull out cast padding to scratch inside the cast because of the hazard of skin breakdown and subsequent potential for infection.

Which of the following client statements identifies a knowledge deficit about cast care? 1. "I'll elevate the cast above my heart initially." 2. "I'll exercise my joints above and below the cast." 3. "I can pull out cast padding to scratch inside the cast." 4. "I'll apply ice for 10 minutes to control edema for the first 24 hours."

2. Advising the client to eat large amounts of cheese. The client in a double hip spica cast should avoid eating foods that can be constipating, such as cheese. Rather, fresh fruits and vegetables should be encouraged and the client should be encouraged to drink at least 2,500 mL/day.

Which of the following interventions would be least appropriate for a client who is in a double hip spica cast? 1. Encouraging the intake of cranberry juice. 2. Advising the client to eat large amounts of cheese. 3. Establishing regular times for elimination. 4. Having the client dangle at the bedside.