fundamentals ch 27 musculoskeletal TEST QUESTIONS

The nurse is caring for a client with a newly placed plaster leg cast. Which actions by the nurse are part of the nursing care for this client? Select all that apply. 1. Assess for capillary refill of the toes. 2. Elevate the casted limb on pillows. 3. Handle the cast with the palms of the hand. 4. Lift the cast by gripping the area of the ankle. 5. Teach about safe items for scratching inside the cast.

ANS: 1, 2, 3 1 This is correct. The nurse should assess circulation to the casted limb by evaluating capillary refill at the toes. 2 This is correct. The nurse should support the limb on pillows in such a way that air circulates all around the cast for even drying. 3 This is correct. The nurse should avoid touching the wet or damp cast with fingers. If it is necessary to touch the cast, the nurse should use only the palms of the hands. 4 This is incorrect. If the nurse finds it necessary to touch the cast, only the palms of the hands should be used. The cast should not be lifted by gripping the ankle. 5 This is incorrect. The nurse should teach the client to avoid putting anything between the cast and the skin beneath it, especially for the purpose of scratching

The LPN/LVN is assigned to care for a client who is in skin traction. Which condition does the LPN/LVN expect to observe? Select all that apply. 1. A trapeze in place over the bed 2. A rope attached to a frame on the limb 3. A pin protruding from the limb 4. An elastic bandage wrap on the limb 5. A suspended weight at the foot of the bed

ANS: 1, 2, 4, 5 1 This is correct. An overhead frame is affixed to the bed with a trapeze, or triangular piece, attached for the client to use as a hand grip when moving in bed. 2 This is correct. One or more ropes are attached to a frame on the client's limb; the other end of the rope has a weight attached. 3 This is incorrect. Pins are not used for skin traction. 4 This is correct. When skin traction is used, the limb is wrapped with an elastic bandage or fitted with a Velcro wrap to which a frame is attached. 5 This is correct. When skin traction is used, the limb is wrapped with an elastic bandage or fitted with a Velcro wrap to which a frame is attached. One or more ropes are attached to the frame, and on the other end of the rope a weight is attached.

Which actions should the nurse perform when performing a neurovascular check on a client? Select all that apply. 1. Ask the client about numbness, burning, or tingling in the affected limb. 2. Compare sensations by touching an affected and unaffected limb with a paper clip. 3. Ambulate the client in order to assess an affected limb for function. 4. Ask the client to move the fingers or toes of the affected extremity. 5. Test capillary refill of the fingers or toes distal to the surgical site or cast

ANS: 1, 2, 4, 5 1 This is correct. The nurse should ask the client about experiencing numbness, burning, or tingling in the affected limb. 2 This is correct. The nurse should test sensation of the affected and unaffected limbs by touching each with a paper clip and asking the client to indicate when the sensation of the paper clip was detected. 3 This is incorrect. Ambulating a client in order to assess the function of an affected limb is not part of a neurovascular check. 4 This is correct. The nurse should ask the client to move the fingers or toes of the affected extremity. Movement should be possible and free of discomfort if motor nerves are unimpaired. 5 This is correct. The nurse should test capillary refill in the nailbeds of the fingers or toes distal to the surgical site or cast and compare it with that in the unaffected limb.

The nurse is caring for a client with mild left-sided weakness who is using a walker for the first time. Which assessments indicate to the nurse that the client is using the walker correctly? Select all that apply. 1. The walker is the height of the client's hip joint. 2. The client grips the handles with elbows at a 90-degree angle. 3. The client stands behind the back legs of the walker. 4. The hand brakes are set before the client sits in the seat if provided. 5. The client moves the affected leg forward with the walker.

ANS: 1, 4, 5 1 This is correct. A walker that is the correct fit will come up to the client's hip joint. This practice also keeps the arms in the correct position 2 This is incorrect. When the client grips the handles, his or her elbows should be bent at a 30-degree angle. 3 This is incorrect. The nurse should ensure that the client stands between, not behind, the back legs of the walker. Standing too far behind the walker can affect balance and lead to falls. 4 This is correct. If the walker is the rolling style with hand brakes, the nurse should ensure that the brakes are set (handles pulled downward) before the client attempts to sit on the walker seat. 5 This is correct. If one leg is weak, the nurse should instruct the client to move the affected leg forward with the walker, then move the unaffected leg forward.

The nurse is providing care for a client who is four days postoperative for a lower limb amputation. The nurse wraps the stump with an elastic bandage. Which additional actions will the nurse perform? Select all that apply. 1. Monitor circulation using capillary refill. 2. Assess for the presence of pain or numbness. 3. Slip two fingers under the proximal end of the wrap. 4. Dangle the limb on the side of the bed for 20 minutes. 5. Encourage the client to soak the limb in warm water.

ANS: 2, 3 1 This is incorrect. The capillary refill of a lower limb is assessed by pressing on the nail bed of the client's toes. A residual limb will not have either pedal pulses or toes to assess. 2 This is correct. The nurse should ask the client if the wrap is painful or if it is causing numbness or tingling in the limb. Positive answer is reason for the nurse to re-wrap the limb. 3 This is correct. The nurse should make certain the wrap is not too tight by ensuring that two fingers can fit underneath the bandage at its proximal end. 4 This is incorrect. A residual limb is generally elevated after surgery to reduce swelling. Depending on the height of the amputation, the client may not be able to dangle the limb safely. 5 This is incorrect. Soaking would not be done with a wrap in place.

The nurse works in a rehabilitation facility. Which action by the nurse will help promote mobility so a client can be discharged home? Select all that apply. 1. Use the continuous passive motion (CPM) machine. 2. Evaluate the client's mobility deficits. 3. Move joints beyond 90 degrees as tolerated. 4. Diligently follow the physician's activity orders. 5. Encourage the client to lie down at set intervals.

ANS: 2, 4 1 This is incorrect. CPM therapy is used most likely in the hospital setting after surgery. CPM therapy is primarily provided for clients after knee surgery or joint replacement. 2 This is correct. When the nurse works in a rehabilitation facility, the nurse should assess for an ongoing need for physical therapy. In the case of a client who may be discharged home, the assessment is still important because physical therapy can be provided in the client's home if needed. 3 This is incorrect. Moving joints beyond 90 degrees as tolerated is not an action that will help promote mobility so that a client can be discharged home. Joint movement beyond 90 degrees is not a necessity for adequate movement and mobility. 4 This is correct. The nurse should diligently follow the physician's activity orders to assist a client to recover mobility in order to be discharged home. 5 This is incorrect. The nurse should encourage the client to rest as needed. Encouraging the client to lie down at set intervals is not necessary

The nurse is caring for a client with diabetes mellitus who is scheduled to have a right below-knee amputation. The nurse assesses which factors that can put this client at risk for amputation? Select all that apply. 1.Psoriasis 2.Bony deformity 3.Limited joint mobility 4.Peripheral neuropathy 5.Peripheral vascular disease 6.History of skin ulcers or previous amputation

ANS: 2,3,4,5,6 Certain conditions place clients with diabetes at increased risk for amputation. These factors include peripheral neuropathy, limited joint mobility, bony deformity, peripheral vascular disease, and a history of skin ulcers or previous amputation. The nurse needs to observe for changes that indicate peripheral neuropathy or vascular insufficiency.

A client who is scheduled for surgery and who is to be placed in skeletal traction says to the nurse, "I'm not sure if I want to have this skeletal traction or if the skin traction would be best to stabilize my fracture." Based on the client's statement, the nurse should make which response to the client? 1."There is no reason to be concerned. I have seen lots of these procedures." 2."Skeletal traction is much more effective than skin traction in your situation." 3."You have concerns about skeletal versus skin traction for your type of fracture?" 4."Your fracture is very unstable. You will die if you don't have this surgery performed."

ANS: 3."You have concerns about skeletal versus skin traction for your type of fracture?" Asking the client if there are concerns about skeletal versus skin traction identifies the therapeutic communication technique of paraphrasing. Paraphrasing is restating the client's message in the nurse's own words. Telling the client the fracture is unstable and you will die if you don't have this surgery, identifies a communication block that reflects a lack of the client's right to an opinion. It also will cause fear in the client. Also, saying that skeletal traction is more effective than skin traction is offering a false reassurance, and this type of response will block communication. In addition, saying that there is no reason to be concerned is also a communication block and reflects a lack of the client's right to an opinion.

The nurse is evaluating a client in skeletal traction. When evaluating the pin sites, the nurse would be most concerned with which finding? 1.Redness around the pin sites 2.Pain on palpation at the pin sites 3.Thick, yellow drainage from the pin sites 4.Clear, watery drainage from the pin sites

ANS: 3.Thick, yellow drainage from the pin sites The nurse should monitor for signs of infection such as inflammation, purulent drainage, and pain at the pin site. However, some degree of inflammation, pain at the pin site, and serous drainage would be expected; the nurse should correlate assessment findings with other clinical findings, such as fever, elevated white blood cell count, and changes in vital signs. Additionally, the nurse should compare any findings to baseline findings to determine if there were any changes. Test-Taking Strategy(ies): Note the strategic word, most. Determine if an abnormality exists. Recall that purulent drainage is indicative of infection, and that some degree of pain, inflammation, and serous drainage should be expected.

The nurse is checking the neurovascular status in a patient with a casted arm. Which findings would the nurse report to the registered nurse (RN) or health-care provider? Select all that apply. 1. Numbness in fingers 2. Increasing edema 3. Pale nailbeds 4. Pulses equal on both arms 5. Capillary refill 6 seconds

Ans: 1, 2, 3 5 This finding should be reported. A decreased sensation or numbness in the affected limb may indicate impairment of sensory nerve function. The nurse should report this finding. Edema indicates impairment of circulation and should be monitored closely to determine if it increases. This should be reported. Assess the color of the skin and nailbeds in the distal portion of the affected limb. These should be the same as in the unaffected limb; nailbeds should be pink. Pallor or cyanosis indicates impairment of circulation. Slower refill time in the affected limb or refill longer than 5 sec indicates that circulation is impaired.

The nurse is reinforcing teaching with a mother of a child who has a sprained ankle. Which statements by the mother would indicate a correct understanding of the teaching? 1. I should let the child rest 2. I will place ice on the ankle 3. I will make sure the bandage stays in place 4. I can take my child back to soccer practice this week 5. I will put pillows under the child's ankle

Ans: 1, 2, 3, 5

The nurse provides care for a postoperative patient with a total knee replacement. Which strategy is appropriate in managing the patient's pain? Select all that apply. 1. Medicate for pain before using the continuous passive motion (CPM) machine. 2. Assess the patient's pain level frequently, using a 0-10 scale. 3. Encourage the patient to avoid analgesics unless pain is severe. 4. Assess pain after the patient uses the CPM machine. 5. Set a patient goal to be pain-free on postoperative day 2.

Ans: 1, 2, 4 1. Medicating for pain if needed before using the CPM machine can promote comfort and tolerance of the activity. 2. It is important to assess pain levels frequently. Adequate pain relief can promote healing, comfort, and rest. 3. The nurse would advise the patient to request pain meds before the pain is severe. 4. The nurse would assess pain before and after using the CPM machine. 5. Although the goal is to manage pain effectively, it may not be realistic to be pain free on postoperative day 2.

Two days later, Ms. Smith is taken to surgery for repair of the fracture (fractured her right fibula). She returns to the unit with a plaster cast. Which action should be considered when caring for a patient with a plaster cast? Select all that apply. 1. Report any drainage or malodorous discharge from the cast or limb. 2. Encourage the patient to insert a coat hanger into the cast to ease itching. 3. Complete neurovascular checks every 2 hours for the first 24 hours. 4. Use the palms of your hands to touch the cast while still wet or damp. 5. Keep the limb flat on the bed to prevent joint contracture.

Ans: 1, 3, 4 Any malodorous discharge or drainage from the cast or limb may indicate an infection, which should be reported. Neurovascular checks should be completed every 2 hours for the first 24 hours after surgery. The palms of the hands should be used when in contact while the plaster cast dries. The limb should be elevated with pillows, not flat on the bed. If the patient uses a coat hanger to scratch beneath the cast, it can abrade the skin and should be avoided.

The nurse is performing a neurovascular check on a patient after hip surgery. Which areas would the nurse monitor? Select all that apply. 1. Check skin temperature 2. Check pupil response 3. Check for tingling 4. Check the ability of the patient to move toes 5. Check capillary refill

Ans: 1, 3, 4, 5 Touch the patient's skin distal to the surgical site or cast with the back of the hand. Assess for warmth and compare to the warmth of the same area on the unaffected limb. Ask the patient if he or she is experiencing numbness, burning, or tingling in the affected limb. Ask the patient to move the toes of the affected extremity. Movement should be free of discomfort if motor nerves are unimpaired. Test capillary refill in the nailbeds of the fingers or toes distal to the surgical site or cast. Compare it to that in the unaffected limb. Slower refill time in the affected limb or refill longer than 5 sec indicates that circulation is impaired.

As part of the routine assessment of Ms. Smith's affected extremity (fractured her right fibula - admitted for fracture reduction via temporary skin traction until surgery and cast placement), which statement represents the correct rationale for actions related to neurovascular checks? Select all that apply. 1. A decreased sensation may indicate impairment of sensory nerve function. 2. Warmer temperature of the skin may indicate impairment of circulation. 3. Pallor or cyanosis indicates impairment of circulation. 4. Faster refill time indicates impairment of circulation 5. Movement should be free of discomfort if motor nerves are intact.

Ans: 1, 3, 5 A decreased sensation may indicate impairment of sensory nerve function. Cooler temperature of the skin may indicate impairment of circulation. Pallor or cyanosis indicates impairment of circulation. Slower refill time indicates impairment of circulation. Movement should be free of discomfort if motor nerves are intact.

You are educating Ms. Smith on the rationale for actions related to care of a plaster cast. Which statement would be included in your education? 1. "Touching the wet cast with your fingers can cause pressure points on the skin beneath the cast." 2. "Frequent neurovascular checks are used to ensure your mental status is intact as you heal." 3. "Petaling is used to cover smooth edges of the cast to prevent skin breakdown." 4. "A hair dryer is often used to speed the rate of drying of the plaster cast."

Ans: 1. "Touching the wet cast with your fingers can cause pressure points on the skin beneath the cast." Touching the wet cast with your fingers can cause pressure points on the skin beneath the cast. Frequent neurovascular checks are used to ensure circulation to the limb is intact, not mental status. Petaling is used to cover rough edges, not smooth edges, to prevent skin breakdown. A hair dryer is typically used to relieve itching, not speed the rate of cast drying.

The nurse is caring for a client after total hip replacement surgery. The nurse knows it is important that the client not move the affected leg to or beyond the midline of the body. Which important piece of equipment for this purpose does the nurse identify?? 1. Abductor pillow 2. Immobilizer 3. Splint 4. Elastic bandage

Ans: 1. Abductor pillow 1 This is correct. An abductor pillow is a wedge-shaped foam pillow, often with Velcro straps, placed between the legs of clients who have had total hip replacement surgery. The pillow keeps hips abducted while the client is in bed, and the Velcro straps keep the pillow in place to prevent shifting. 2 This is incorrect. An immobilizer is soft fabric with firm internal stays that opens and closes with Velcro fasteners. It is used to protect an injured limb and to keep its joints from flexing. This is not the correct choice for this client. 3 This is incorrect. A splint is a firm plastic molded form used to keep a joint or joints from flexing. It may be applied to a limb and wrapped in place with gauze or an elastic bandage. This is not the correct choice for this client. 4 This is incorrect. An elastic bandage is a woven bandage containing elastic to stretch as it is wrapped around an injured area. Elastic helps compress the area to decrease edema. This is not the correct choice for this client.

The nurse assists the registered nurse (RN) in the provision of care for a patient who is recently postoperative for amputation of the left leg. The nurse reports that the patient's blood pressure is lower than earlier in the day, and their heart rate has increased. The patient's temperature, respiratory rate, and oxygen saturation level are within normal limits. Which postoperative complication would the nurse suspect based on the current data? 1. Hemorrhagic shock 2. Infection 3. Joint dislocation 4. Wound dehiscence

Ans: 1. Hemorrhagic shock Changes that could indicate shock include decreased blood pressure and increasing pulse rate.

The nurse is caring for a patient who has an Ilizarov frame. The nurse is most likely caring for which patient? 1. One whose left leg is shorter than the right after a vehicle accident 2. One whose spine is severely curved since birth 3. One who has osteoarthritis from wear and tear on the body 4. One who has an amputation from a limb that developed gangrene

Ans: 1. One whose left leg is shorter than the right after a vehicle accident The Ilizarov frame is also used in situations in which one leg has been left shorter than the other after trauma. By turning screws in the frame, the rings separate slightly; over time, the bone grows to fill in the gap. This allows for a very gradual increase in bone length to help the legs become more even.

When educating the patient on the appropriate technique for the use of crutches, the nurse should include which statement? Select all that apply. 1. "Bear weight on the axillary pads." 2. "When walking up stairs, move the unaffected leg first." 3. "When walking down stairs, move the unaffected leg first." 4. "Keep the affected foot forward rather than bending the knee." 5. "Crutch tips should be positioned 3 inches to the side of the foot while measuring."

Ans: 2, 3, 5 2. When ascending stairs with crutches, it is advised to lead with the unaffected leg, placing it on the step first. This provides stability and helps to maintain balance while climbing. 3. When descending stairs with crutches, it is recommended to move the affected leg first. This allows the patient to control the descent and provides support while stepping down. 5. When measuring for crutches, the crutch tips should be positioned about 3 inches to the side of the foot. This ensures proper support and stability while using the crutches.

The nurse is reinforcing teaching about the four-point gait to a patient with an affected left leg. In which gait sequence does the nurse instruct the patient? 1. Patient moves the left leg forward 2. Patient moves the left crutch forward 3. Patient moves the right crutch forward 4. Patient moves the right foot forward

Ans: 2, 4, 3, 1 For patients able to bear weight on the affected limb, the patient moves the first crutch forward, then the opposite foot forward: the patient then moves the remaining crutch forward, then the remaining affected foot forward.

The nurse wraps a patient's elbow. Which findings would cause the nurse to rewrap the bandage more loosely? Select all that apply. 1. The bandage sags when the patient stands up. 2. The patient states that they cannot feel their fingers. 3. The nurse can slip two fingers underneath the proximal end. 4. The patient cannot move their fingers. 5. The patient's fingers are slightly blue.

Ans: 2, 4, 5

As part of the nursing care for skin traction, which of the following actions should be considered? Select all that apply. 1. Perform pin-site care frequently with normal saline. 2. Ensure the weights hang freely and do not rest them on the floor. 3. Shave hair in the area of skin traction to prevent infection. 4. Ensure the ropes pull in a straight line without crossing. 5. Keep the patient's body in proper alignment.

Ans: 2, 4, 5 Skin traction does not use pins for bone realignment. Weights should hang freely for all types of traction with the ropes maintained in a straight line. The patient's body should remain in proper alignment so that the traction pulls correctly. Hair should be shaved in the event of cervical traction use, not skin traction.

The nurse is assisting the registered nurse (RN) in developing a plan of care for a patient with impaired mobility from hip replacement surgery. Place in order the necessary steps. 1. Plan outcome to reduce pain to at least a 4 on a 0-10 scale 2. Observe patient after surgery moaning and saying that pain is at a level 8 on a 0-10 scale 3. Ask the patient to rate pain level after interventions 4. Encourage pain medication and deep breathing 5. Contribute data to the development of acute pain nursing diagnosis

Ans: 2, 5, 1, 4, 3

The nurse is providing care for a client who is four days postoperative for a lower limb amputation. The nurse wraps the stump with an elastic bandage. Which additional actions will the nurse perform? Select all that apply. 1. Monitor circulation using capillary refill. 2. Assess for the presence of pain or numbness. 3. Slip two fingers under the proximal end of the wrap. 4. Dangle the limb on the side of the bed for 20 minutes. 5. Encourage the client to soak the limb in warm water.

Ans: 2,3

The nurse is educating the patient on the correct use of a walker. Which statement by the patient would cause concern? 1. "I should stand between the back legs of the walker." 2. "I would move the unaffected leg forward first." 3. "I need to pick up the walker, set it down, and then move forward." 4. "I need to make sure the brakes are set before sitting down."

Ans: 2. "I would move the unaffected leg forward first."

You are providing education to Ms. Smith on skin traction. Which statement would be included in the education? 1. "Skin traction uses wires, rods, and tongs to hold the bone in place." 2. "Skin traction is used to prevent severe muscle spasm until surgery can be completed." 3. "Skin traction uses an elastic sleeve to help decrease edema of the affected limb." 4. "Skin traction consists of a plaster or fiberglass encasement used to immobilize the limb."

Ans: 2. "Skin traction is used to prevent severe muscle spasm until surgery can be completed." Skin traction involves the use of ropes, pulleys, and weights to align bone ends after a fracture; weights are attached to a frame held in place with elastic bandages or other wrap on the skin. It may be used to prevent severe muscle spasm resulting from displaced bones until surgery can be performed.

You are educating a patient about plaster cast maintenance. Which statement would be included in your education? 1. "Complete neurovascular checks every 6 hours." 2. "Use the palms of your hands to touch the cast when it is still wet." 3. "Keep the limb flat on the bed to prevent joint contracture." 4. "Insert a coat hanger into the cast to ease itching."

Ans: 2. "Use the palms of your hands to touch the cast when it is still wet."

Which patient would the nurse most likely observe using a knee scooter? 1. A patient who had knee replacement surgery 2. A patient who has a broken ankle 3. A patient who sprained the left knee running 4. A patient who has an anterior cruciate ligament tear

Ans: 2. A patient who has a broken ankle Knee scooters, or knee walkers, are helpful for patients who cannot bear weight on a foot or ankle, such as after a surgery or due to sprains, fractures, gout, or a below-the-knee amputation.

Which crutch gait would the nurse reinforce to a patient who is unable to bear weight on the right broken foot? 1. A two-point gait 2. A three-point gait 3. A four-point gait 4. A swing-to gait

Ans: 2. A three-point gait The three-point gait is for patients who are unable to bear weight on the affected limb.

The nurse is caring for a patient in tongs. Which strategy should the nurse use? 1. Use a clean technique to care for the pin sites. 2. Allow time to discuss altered body image. 3. Keep the patient in a supine position at all times. 4. Change the subject when the patient starts to cry.

Ans: 2. Allow time to discuss altered body image. The hair in the area usually has been shaved to decrease the chances of infection. Tongs are also placed on either side of the skull.

The nurse works in an orthopedic unit in the hospital and is providing care for four clients. Which client does the nurse identify as having a potential need for amputation? 1. A young adult client with a comminuted fracture of the left femur from a car accident 2. An adult client with gangrene of the left foot due to decreased circulation 3. An older adult client with a long history of arthritis in both knees 4. A middle age client with a newly developed diabetic foot ulcer

Ans: 2. An adult client with gangrene of the left foot due to decreased circulation 1 This is incorrect. A comminuted fracture involves multiple bone pieces, but it should heal without amputation. Surgery may be required to align the bone segments with or without the use of metal pieces. 2 This is correct. The client who has developed gangrene due to poor circulation has damage that is beyond recovery. This is the client with the potential for amputation. 3 This is incorrect. Clients of advanced age and long histories of osteoarthritis can be treated with physical therapy, medications, arthroscopy, and/or joint replacement. Amputation is not usually a consideration for these clients. 4 This is incorrect. Amputation may eventually be necessary in clients with diabetes mellitus who develop a foot ulcer, but medical treatment would be instituted first.

The health-care provider's prescription for the continuous passive motion (CPM) machine is as follows: settings of 30° of flexion at 10°/min to start and advance to 70° of flexion at 30°/min as tolerated. It is now day two. At which setting should the CPM machine be set? 1.Twenty degrees of flexion at 15°/min 2. Forty degrees of flexion at 20°/min 3. Seventy degrees of flexion at 30°/min 4. Eighty degrees of flexion at 35°/min

Ans: 2. Forty degrees of flexion at 20°/min This is correct because it is slowly advancing the CPM machine, just as the health-care provider prescribed.

The nurse is caring for a patient in tongs. Which area would the nurse monitor closely? 1. Lower leg 2. Head 3. Upper arm 4. Hip

Ans: 2. Head The tong insertion sites are located on either side of the skull.

The nurse is checking the patient's incision from knee surgery. Which finding indicates the incision is healing? 1. Thick yellow drainage from the incision 2. Incision edges approximated 3. 102°F (38.9°C) oral temperature 4. Redness 2 in. (5.08 cm) around incision

Ans: 2. Incision edges approximated

The nurse and the assistive personnel are caring for a patient after a direct anterior approach for a hip replacement. Which action by the assistive personnel would cause the nurse to intervene? 1. Assisting the patient to turn 2. Placing an abduction pillow between the patient's legs 3. Assisting the patient with the use of a bedpan 4. Allowing the patient to cross legs for comfort

Ans: 2. Placing an abduction pillow between the patients' legs The nurse would need to intervene because this is not needed after a direct anterior approach for a hip replacement, With this type of surgery, the patient does not have to avoid adducting the leg, so there is no need for use of an abduction pillow.

The LPN/LVN approaches and asks the RN to check and make sure the continuous passive motion (CPM) machine is set up correctly before it is turned on. Which assessment by the RN is most important? 1. Verify that the sheepskin does not have any folds. 2. Stand at the foot of the bed to inspect the alignment. 3. Check to see whether the CPM machine is plugged in. 4. Validate that the settings are as prescribed by the physician.

Ans: 2. Stand at the foot of the bed to inspect the alignment. 1 This is incorrect. Although it is important the sheepskin does not have folds, this assessment is not the most important. 2 This is correct. It is important that a nurse line up the machine so that the break in the platform is centered beneath the client's knee. It is also important to ensure that the CPM machine is positioned so that support to the leg is maintained in correct body alignment with the hips and the rest of the body. The only way for a nurse to verify this positioning is to stand at the foot of the bed and inspect the visual alignment of the CPM machine with the hips and torso. 3 This is incorrect. Checking to see if the CPM machine is plugged in is important; however, this is not the most important assessment. 4 This is incorrect. Before initiating the therapy, the nurse should check the physician's orders for the settings. Although this is important, it is not the most important of the options provided.

Which health-care team member is priority when working with a patient in rehabilitation after an amputation? 1. The registered nurse (RN) 2. The physical therapist (PT) 3. The licensed practical nurse/licensed vocational nurse (LPN/LVN) 4. The medical pathologist

Ans: 2. The physical therapist (PT) PTs are the members of the health-care team responsible for assessing musculoskeletal deficiencies and developing the plan of care to strengthen muscles and restore mobility.

While in skin traction, you advocate to the health-care team to allow Ms. Smith to use a _________ to assist in bed mobility and muscle strength. 1. External fixator 2. Trapeze bar 3. Ilizarov frame 4. Continuous passive motion machine

Ans: 2. Trapeze bar Patients in skin traction are immobilized from the waist down. A triangular trapeze bar can be attached to an overhead frame that is affixed to the bed for the patient to use as a hand grip when moving in bed and to promote upper body muscle strength.

Which actions should the nurse take when caring for patients with musculoskeletal issues? Select all that apply. 1. Flex the patient's hip immediately after total hip replacement surgery. 2. Check for capillary refill in a patient with an amputation. 3. Reinforce going down the stairs to start with the affected leg and crutches. 4. Make sure the walker hand brakes are pulled down before the patient sits in a walker seat 5. Position the quad cane 4 in. (10 cm) away from the side of the foot.

Ans: 3, 4, 5 3. Instruct the patient that when he or she is walking down the stairs on crutches, the patient should place the crutches and the affected leg on the downward step, then bring down the unaffected leg. 4. If the walker is the rolling style with hand brakes, ensure that the brakes are set (handles pulled downward) before the patient attempts to sit on the walker seat. 5. A cane is the correct height when the top of it is even with the patient's hip joint as the tip is positioned 4 in. (10 cm) away from the side of the foot.

Which information should the nurse share with a patient about skin traction? 1. "It will help you remember to keep your legs apart." 2. "It uses pins and weights to help align bones." 3. "It will help decrease muscle spasms." 4. "It uses weights to help calcium move into the bone."

Ans: 3. "It will help decrease muscle spasms." 1. An abductor pillow keeps patient's legs abducted after total hip surgery. 2. While skin traction does use weights, skeletal traction uses pins. 3. Skin traction may be used to prevent severe muscle spasms due to displaced bones until surgery can be performed. 4. Skin traction involves the use of ropes, pulleys, and weights to align bone ends after a fracture. It does not allow calcium to enter the bone.

The patient with a leg amputation asks the nurse why a compression sock is used. What is the nurse's best response? 1. "This helps lessen the disturbed body image issues." 2. "This helps decrease the pain from healing." 3. "This helps mold the stump to fit the artificial leg." 4. "This helps lessen the redness of the incision."

Ans: 3. "This helps mold the stump to fit the artificial leg." If left to heal on its own, the stump will have a squared-off shape. However, in order to fit into the socket of a prosthetic limb, the stump must have a smooth, rounded shape.

The nurse is caring for a client who just had a plaster cast applied for a lower leg fracture. The client states, "Why this kind of cast? My friend got a fiberglass cast." The nurse will make which comment to address the client's statement? 1. "The plaster cast is the most effective type of immobilization." 2. "With a plaster cast, it is easier to monitor progress with x-rays." 3. "You will probably have a fiberglass cast in a couple of weeks." 4. "Actually, a plaster cast is lighter and more durable than fiberglass."

Ans: 3. "You will probably have a fiberglass cast in a couple of weeks." 1 This is incorrect. The plaster cast is most useful as the initial method of immobilization because it can be molded easily to a precise shape for maintaining bone alignment. However, there are a variety of methods to accomplish immobilization. 2 This is incorrect. Fiberglass casts are penetrated better by x-ray, so the healing bone can be visualized for progress. 3 This is correct. After one or two weeks of healing, the plaster cast can be replaced with a fiberglass cast. 4 This is incorrect. Fiberglass casts are more durable, lighter in weight, and allow for better air circulation than plaster casts.

The nurse is caring for clients on an orthopedic unit. Which client will be the nurse's immediate concern after receiving report? 1. A client reporting pain at a 3 on a 0 to 10 scale 2. A client reporting warmth and itching under a plaster cast 3. A client with redness and purulent drainage at an external pin site 4. A client with a hip replacement who needs assistance when ambulating

Ans: 3. A client with redness and purulent drainage at an external pin site 1 This is incorrect. Although the client will need the nurse's attention, pain at 3 on a 0 to 10 scale is not considered intolerable. This client is not the nurse's immediate concern. 2 This is incorrect. When a plaster cast is in place, the client will frequently experience itching; sometime the client feels warmth as the cast "cures." This client is not the nurse's immediate concern. 3 This is correct. Redness and drainage noted at an external pin site will be the nurse's immediate concern. Fixators penetrate the skin and enter the bone, providing a pathway for pathogens to enter the body. The client needs interventions to validate the presence of infection and start treatment in a timely manner. 4 This is incorrect. A client with a hip replacement who needs assistance when ambulating is not a concern for the nurse. Depending on the client and the time lapse since surgery, this need may be expected.

In preparation for discharge, you begin to fit Ms. Smith for crutches. Which measurement information should be considered when appropriately sizing a patient for crutches? 1. Crutches fit correctly when there are two fingerbreadths of space below the axilla. 2. Measurement should occur with the crutch tips 4 to 6 cm to the side of the heel. 3. Crutches fit correctly when there are three fingerbreadths of space below the axilla. 4. Measurement should occur with the crutch tips 10 to 15 inches to the side of the heel.

Ans: 3. Crutches fit correctly when there are three fingerbreadths of space below the axilla. Crutches fit correctly when there are three fingerbreadths of space between the crutch's axillary pad and the patient's axilla when the patient is standing with the crutch tips 4 to 6 inches (10 to 15 cm) to the side of the heel.

The nurse is caring for a patient with a lateral approach left hip arthroplasty. Which action should the nurse take? 1. Remove the abductor pillow when turning the patient. 2. Turn the patient to the left side q2h. 3. Do not let the patient bend forward when getting out of bed. 4. Place the left leg over the right leg at intervals.

Ans: 3. Do not let the patient bend forward when getting out of bed. When the nurse assists the patient to get out of bed, to sit in a chair, or to use the bedside commode, the nurse must be very careful that the patient does not lean forward at any time, because that would flex the hip beyond 90° and possibly cause hip dislocation.

The nurse is caring for a client who had a motor vehicle accident resulting in a comminuted fracture of the right fibula. After healing, the client's right leg is shorter than the left. Treatment to correct the defect involves the placement of an Ilizarov frame. Which process does the nurse expect with the treatment? 1. The left leg will be immobilized until the right leg lengthens. 2. Muscles of the right leg are stretched to lengthen the bone. 3. In small increments, the right leg will become longer. 4. Bone shortening of the left leg will require immobilization.

Ans: 3. In small increments, the right leg will become longer. 1 This is incorrect. The right leg will not lengthen without treatment. There is no reason to immobilize the left leg. 2 This is incorrect. The right leg is shorter because of bone length; stretching the muscles of the right leg will not result in an increase of leg length. 3 This is correct. An Ilizarov frame will be attached to the right leg and screws in the frame are turned to slightly separate the rings, and then bone grows to fill in the gap. This method of treatment causes a very gradual increase in bone length. 4 This is incorrect. The left leg will not be shortened and will not require use of an Ilizarov frame for immobilization.

The nurse is contributing to the plan of care for a patient with a total right knee replacement. Which interventions should the nurse recommend including in the plan of care? Select all that apply. 1. Test sensation of both legs by using a paper clip. 2. Ask if there is any tingling or burning in left leg. 3. Touch the patient's thigh to determine the temperature of the skin. 4. Observe the color of the skin in the lower right leg and feet. 5. Ask patient to move toes on the right leg

Ans: 1, 4, 5 1. Test sensation of the affected and unaffected limbs by touching each with a paper lip and asking the patient to tell the nurse when he or she feels the sensation of the paper clip touching the limb. A decreased sensation in the affected limb may indicate impairment of sensory nerve function. 2. Ask the patient if he or she is experiencing numbness, burning, or tingling in the affected limb. The patient's affected limb is the right leg, not the left. 3. Touch the patient's skin distal to the surgical site (lower leg) with the back of the hand. Assess for warmth and compare to the warmth of the same area on the unaffected limb. Cooler temperature of the affected limb, may indicate impairment of circulation. 4. Assess the color of the skin and nailbeds in the distal portion of the affected limb. These should be the same as in the unaffected limb. Pallor or cyanosis indicates impairment of circulation. 5. Ask the patient to move the fingers or toes of the affected extremity. Movement should be free of discomfort if motor nerves are unimpaired.

The nurse is caring for a client with a newly placed plaster leg cast. Which actions by the nurse are part of the nursing care for this client? Select all that apply. 1. Assess for capillary refill of the toes. 2. Elevate the casted limb on pillows. 3. Handle the cast with the palms of the hand. 4. Lift the cast by gripping the area of the ankle. 5. Teach about safe items for scratching inside the cast.

Ans: 1,2,3

The LPN/LVN is assigned to care for a client who is in skin traction. Which condition does the LPN/LVN expect to observe? Select all that apply. 1. A trapeze in place over the bed 2. A rope attached to a frame on the limb 3. A pin protruding from the limb 4. An elastic bandage wrap on the limb 5. A suspended weight at the foot of the bed

Ans: 1,2,4,5

The nurse is caring for a client with mild left-sided weakness who is using a walker for the first time. Which assessments indicate to the nurse that the client is using the walker correctly? Select all that apply. 1. The walker is the height of the client's hip joint. 2. The client grips the handles with elbows at a 90-degree angle. 3. The client stands behind the back legs of the walker. 4. The hand brakes are set before the client sits in the seat if provided. 5. The client moves the affected leg forward with the walker.

Ans: 1,4,5

During education on a three-point crutch gait, you will provide which statement to Ms. Smith in preparation for discharge? 1. "Move both crutches and the affected limb forward at the same time without touching down or placing weight on it." 2. "Move one limb and the opposite crutch forward at the same time, then move the remaining limb and crutch forward." 3. "Move the first crutch forward, then the opposite limb; move the remaining crutch forward, then the affected limb." 4. "Move both crutches forward at the same time, then swing both limbs forward to the level of the crutches."

Ans: 1. "Move both crutches and the affected limb forward at the same time without touching down or placing weight on it." A three-point gait is for patients who are unable to bear weight on the affected limb. The patient moves both crutches and the affected limb forward at the same time without touching down or placing weight on it, and then brings the unaffected foot forward.

The nurse is preparing discharge teaching for a client who is going home after a total knee replacement. Which home safety assessment should the nurse make? 1. Ask the client about plans for meal preparation during recovery. 2. Check whether the client has arranged for an elevated toilet seat. 3. Inquire whether the client needs to go up steps for sleeping and the bathroom. 4. Determine the client's understanding about follow-up appointments

Ans: 3. Inquire whether the client needs to go up steps for sleeping and the bathroom. 1 This is incorrect. The nurse should assess about meal plans because adequate nutrition is an important part of healing; however, this is not a safety assessment. 2 This is incorrect. Clients with a total knee replacement do not necessarily need an elevated toilet seat. This assessment is appropriate for a client after a total hip replacement; it is important not to flex the hip greater than 90 degrees to avoid dislocation of the hip prosthesis. 3 This is correct. It is an important safety assessment for the nurse to inquire if the client needs to go upstairs for sleeping and the bathroom. The client should be taught how to go up and down steps prior to discharge; however, multiple trips up and down stairs can present a safety issue for clients after hospitalization and a joint replacement. 4 This is incorrect. The nurse needs to make sure the client understands about making and keeping follow-up appointments; however, this is not a safety assessment.

The nurse is caring for a patient with a total hip replacement. Which instruction should the nurse reinforce to the patient? 1. Lean forward when getting off the bedside commode. 2. Bend over when putting slippers on. 3. Keep the back straight when getting out of bed. 4. Pick items off the floor to increase flexibility.

Ans: 3. Keep the back straight when getting out of bed. Assist the patient out of bed carefully to prevent flexion of the hip more than 90°.

The nurse is caring for a patient in traction. Which action should the nurse take? 1. Allow the patient's foot to touch the end of the bed. 2. Let the weight rest on the floor. 3. Keep the ropes straight on the pulleys 4. Make sure there is enough slack to prevent crossing of lines.

Ans: 3. Keep the ropes straight on the pulleys

The nurse is preparing a client for a diagnostic procedure on an injured shoulder. The client reports extreme pain with shoulder movement. The client's medical history indicates no significant health issues and no previous surgeries. Which diagnostic testing will the nurse anticipate? 1. Radiographic studies 2. Computed tomography (CT) 3. Magnetic resonance imaging (MRI) 4. Measurements of shoulder mobility

Ans: 3. Magnetic resonance imaging (MRI) 1 This is incorrect. Radiographic studies (x-rays) are useful for the diagnosis of suspected fractures or significant trauma. Shoulder injuries frequently involve soft tissue damage, so this is not the anticipated test. 2 This is incorrect. CT scans are useful further to diagnose fractures that are difficult to identify with x-rays, as well as congenital abnormalities of the musculoskeletal system. This would be the anticipated test if the client had metal implants. 3 This is correct. MRI scans are used to diagnose pathological fractures and congenital abnormalities of the spine. This test also is best for diagnosing soft tissue when the client has joint injury, or ligament, tendon, or muscle tears. The client's medical history does not indicate a contraindication to an MRI. 4 This is incorrect. Measurements of shoulder mobility are primarily performed by a physical therapist; however, this is an assessment process and is not diagnostic.

The nurse is observing a patient with a weak left leg walk with a cane. Which patient action indicates a correct understanding of using a cane? 1. Places the cane by the left leg 2. Leans over the cane while walking 3. Moves the left leg and cane together, then the right leg 4. Has the height of the cane to the top of the hip bone

Ans: 3. Moves the left leg and cane together, then the right leg

The nurse is preparing a patient for a computed tomography (CT) scan. The nurse is most likely caring for which patient? 1. One who has widespread disease of the bones, like cancer 2. One who has an identifiable fracture on x-ray 3. One who has congenital abnormalities of the musculoskeletal system 4. One who has a torn tendon of the left knee

Ans: 3. One who has congenital abnormalities of the musculoskeletal system CT scans are used to view congenital abnormalities of the musculoskeletal system.

The nurse is contributing to the plan of care for a patient with a continuous passive motion (CPM) machine after left knee surgery. Which intervention should the nurse recommend including in the patient's plan of care? 1. Take the patient to physical therapy for CPM treatments. 2. Inform the patient that pain medication is rarely needed. 3. Position the break in the platform beneath the patient's popliteal area. 4. Check the patient's body alignment by standing on the left side of the bed.

Ans: 3. Position the break in the platform beneath the patient's popliteal area. It is important that the nurse line up the machine so that the break in the platform is centered beneath the patient's knee (popliteal area).

The nurse is providing care for a client with cervical skeletal traction following surgery. Which action is contraindicated when caring for this client? 1. Make sure that weights are hanging freely and off the floor. 2. Ensure that ropes are not crossed and pull in a straight line. 3. Remove weights when turning the client and then replace. 4. Provide pin care or assessment as ordered by the physician.

Ans: 3. Remove weights when turning the client and then replace. 1 This is incorrect. This is not contraindicated care for a client in cervical traction with tongs. The nurse needs to assure that the weights are hanging freely and off the floor. 2 This is incorrect. The nurse needs to make sure the ropes are not crossed and pull in a straight line. This is not contraindicated care for a client in cervical traction with tongs. 3 This is correct. Removing the weights when turning a client in cervical traction with tongs is contraindicated. The weight may be lifted slightly to provide enough slack in the rope to move the client. The weight is then slowly and gently lowered into place. 4 This is incorrect. Pin care and pin site assessment is performed as ordered. However, many physicians are no longer ordering this intervention because the moisture can promote bacterial growth.

A patient has returned from surgery after a right knee replacement. Which pulse is priority for the nurse to monitor for impaired circulation? 1. Radial pulse 2. Apical pulse 3. Right pedal pulse 4. Right femoral pulse

Ans: 3. Right pedal pulse 1. The patient had knee surgery. The radial pulse is not as important as pulses that are distal to the incision. 2. The apical pulse is not the priority pulse in this situation. 3. Assess the patient's circulation distal to the surgery site to detect impaired circulation. 4. While this pulse is important, it is not the priority because it is not distal to the incision.

A patient is having a follow up at the clinic for a cast. The patient reports itching under the cast. What would the nurse suggest? 1. Use a blunt plastic hanger. 2. "Petal" the cast. 3. Set a small hair dryer on the cool setting. 4. Spray warm water down the leg.

Ans: 3. Set a small hair dryer on the cool setting. 1. If the patient uses an implement such as an ink pen or straightented coat hanger to scratch beneath the cast, it can abrade the skin. 2. "Petaling" a cast is to protect the skin from rough or cracking edges. 3. One alternative is to use a portable hair dryer to blow cool air down the cast to relieve the itching. 4. Warm water down the leg could cause damage to the skin and cast.

A patient with a weak left leg is using a walker. Which patient finding would the nurse praise? 1. The patient's elbows are bent at a 20° angle. 2. The patient's walker is at waist level. 3. The patient moves the left leg with the walker, then the right. 4. The patient stands behind the walker's back legs with the right leg.

Ans: 3. The patient moves the left leg with the walker, then the right. If one leg is weak, instruct the patient to move the affected leg (left) forward with the walker, then move the unaffected (right) leg forward.

A patient has a direct anterior approach for a total hip replacement. In which area would the nurse collect data about the incision? 1. Inner thigh 2. Side of the hip 3. Top of the hip 4. Backside of the hip

Ans: 3. Top of the hip 1. There is no inner thigh incision for a direct anterior approach. 2. A lateral approach hip arthroplasty will have an incision on the side of the hip. 3. A somewhat newer approach to performing this surgery is called the direct anterior approach, which involves a 3. To 4 in incision in the front of the hip instead of a longer one along the side of the hip. 4. In an anterior approach the incision is on the top (anterior), not the bottom posterior.

The nurse is providing care for a client after an above-the-knee amputation one day ago. Which nursing care is most important during the initial postoperative period? 1. Providing emotional support to the client 2. Observing the incision site for signs of infection 3. Wrapping the stump with an elastic bandage 4. Assessing the client frequently for pain levels

Ans: 3. Wrapping the stump with an elastic bandage 1 This is incorrect. It is expected that a client will require emotional support due to an amputation. Although this is important, of the options provided, this is not the most important aspect of care. 2 This is incorrect. It is not anticipated that a client's incision will exhibit signs of infection on the first day postoperative. However, the nurse will check the suture line frequently to make sure the incision does not break open. 3 This is correct. Wrapping the stump with an elastic bandage to promote stump shaping is the most important care for the nurse to provide during the postoperative period. The shape of the stump needs to be compatible with the use of a prosthesis. Left to heal on its own, the stump will heal in a squared-off shape. 4 This is incorrect. Pain management is an important part of post-surgical nursing care; however, of the options provided, wrapping the stump is most important due to the long-term impact of this action

When measuring a patient for an appropriate fit of a walker, the nurse should make sure the elbows are flexed at what angle? 1. 15 degrees 2. 20 degrees 3. 25 degrees 4. 30 degrees

Ans: 4. 30 degrees

The nurse is caring for a client admitted after plaster cast placement for a comminuted fracture of the lower leg. Which nursing intervention is most important for the nurse to perform? 1. Position the casted limb on pillows to enhance drying. 2. Monitor the client's pain level and medicate as needed. 3. Assist the client to walk to the bathroom using crutches. 4. Perform neurovascular checks every 2 hours for the first 24 hours

Ans: 4. Perform neurovascular checks every 2 hours for the first 24 hours. 1 This is incorrect. While it is appropriate for the nurse to place the casted limb on pillows to promote drying of the cast, it is not the most important nursing intervention at this time. 2 This is incorrect. The client will need pain management, and the nurse should monitor the pain level and medicate the client as needed; however, this is not the most important nursing intervention at this time. 3 This is incorrect. The client is likely to be ordered on bed rest until the cast is dry and physical therapy has taught the client how to safely use crutches. The nurse should assist the client to use a bedpan or urinal. 4 This is correct. It is most important for the nurse to perform neurovascular checks after the placement of a cast for a fracture. The nurse recognizes that the client's circulation may be compromised by the cst or due to swelling in the leg. Neurovascular checks are performed every 2 hours for the first 24 hours, or as needed. The most distal point is checked for warmth, feeling, capillary refill, movement, color, pulses, pain, and paresthesia or other sensations.

The nurse is caring for a postoperative patient with a hip arthroplasty. Which action by the patient indicates appropriate pain management by the nurse? 1. Takes pain medication before leg is placed in continuous passive motion (CPM) machine 2. Asks for pain medication when the pain is a 7 on a 0-10 scale 3. Works through the pain when ambulating 4. Rates the pain as a 3 on a 0-10 scale

Ans: 4. Rates the pain as a 3 on a 0-10 scale The obvious goal is to keep the patient comfortable, and, when planning a goal for that, nurses often say that the pain should be at a 4 or below because it may be impossible for the patient to be totally pain free in the first few days after surgery.

The nurse in a rehabilitation facility attends a meeting to discuss client status. For which reason does the nurse recognize attendance by the physical therapist? 1. The physical therapist is a required part of facility's staff to qualify for reimbursement. 2. The physical therapist teaches nurses how to implement exercise and strengthening plans. 3. The physical therapist sets an example for staff about how to physically motivate clients. 4. The physical therapist assesses for musculoskeletal deficiencies and makes a recovery plan.

Ans: 4. The physical therapist assesses for musculoskeletal deficiencies and makes a recovery plan. 1 This is incorrect. The physical therapist is not maintained as part of the health-care staff in order that the facility will qualify for reimbursement. 2 This is incorrect. The physical therapist is not part of the health-care staff in order to teach nurses how to implement exercise and strengthening plans. 3 This is incorrect. The physical therapist is not part of the health-care staff in order to set an example for the staff about how to physically motivate the clients. 4 This is correct. The physical therapist is an important staff member at a rehabilitation facility. The physical therapist is responsible for assessing clients for musculoskeletal deficiencies and for formulating a plan for each client to recover optimal ability.

The nurse is caring for a patient in a plaster cast that is drying. Which action should the nurse take? 1. Lay the cast flat on the bed. 2. Use fingers to lift the cast. 3. Turn the spica cast with abductor bar. 4. Use palms to position the cast.

Ans: 4. Use palms to position the cast. If it is necessary to touch the cast, use only the palms of the nurse's hands.

The nurse is caring for a patient with crutches from a broken right leg. Which instruction should the nurse reinforce? 1. When standing, bend the knee and hold the right leg behind the crutches. 2. Make sure there is 1 fingerbreadth between the crutch pad and the axilla. 3. Bear weight on the underarms when standing with crutches. 4. When walking up the stairs, place the left leg first, then the crutches and the right leg

Ans: 4. When walking up the stairs, place the left leg first, then the crutches and the right leg Instruct the patient that when he or she is walking up the stairs on crutches, the patient should place the unaffected leg on the step, then move up the crutches and the affected leg.

The nurse is placing a patient's leg into a continuous passive motion (CPM) machine. Which sequence would the nurse follow? 1. Place the patient's leg in the machine. 2. Observe the machine as it flexes and extends. 3. Place the sheepskin on the platform. 4. Turn the machine on. 5. Place the CPM machine on the bed. 6. Set the degree of flexion.

Ans: 5, 3, 1, 6, 4, 2 1. Place the CPM machine on the bed and connect it to the power source. 2. Place the sheepskin on the platform where the patient's leg will rest, especially at the end near the gluteal fold to prevent pressure on the patient's skin, which could lead to a pressure ulcer. 3. Position patient's leg in the CPM machine so that the break in the platform is centered beneath the patient's knee. 4. Set the degrees of flexion and speed as ordered by the health-care provider. 5. Turn on the CPM machine. 6. Observe the machine as it flexes and extends the patient's knee and ensure that the passive exercise is being well tolerated by the patient.

The client is being educated about the use of crutches after a cast was applied to his left ankle. What directions by the nurse are most important before discharge? a. "Don't lean or swing on the crutches." B. "Be careful of slippery floors and puddles." C. "Let me see you use the crutches to walk around the nurses' station." D. "Keep the crutches close to you during the night in case you need to get up."

Ans: C. "Let me see you use the crutches to walk around the nurses' station."

Upon discharge, Miriam is instructed to continue using a walker until the follow-up visit with her surgeon in 2 weeks. What instructions need to be included with the use of the walker? a. Advance the walker far ahead of your body and walk toward it. B. Slide the walker with each step. C. Move your weaker leg forward as your walker moves forward. D. Stand well behind the back legs. E. Size does not matter; any size walker will work.

Ans: C. Move your weaker leg forward as your walker moves forward.

The nurse is caring for a client recently admitted to the unit after a right knee replacement. Which assessment finding is most concerning to the nurse? 1. Pedal pulses on the operative foot are weak compared to the non-operative side. 2. The surgical dressing exhibits a moderate amount of serosanguineous drainage. 3. A patient-controlled analgesia pump is set up according to physician orders. 4. The client has an indwelling urinary catheter draining clear straw-colored urine.

Ans: 1. Pedal pulses on the operative foot are weak compared to the non-operative side. 1 This is correct. The nurse is most concerned when the client's circulation check to the extremities indicates a notable difference between the operative and non-operative side. The nurse understands that this finding may indicate an issue with perfusion from a variety of causes. 2 This is incorrect. It may be unexpected for the nurse to notice a small to moderate amount of serosanguineous drainage on a surgical dressing. The nurse should outline the borders, initial the area, and write the time of assessment. The nurse will continue to monitor the amount of drainage and contact the physician if there are indications of increased bleeding 3 This is incorrect. The nurse needs to be sure that the client understands the use of patient-controlled analgesia. Other assessments will include effectiveness, level of sedation, respiratory status, and intravenous patency. However, this is not the nurse's most concerning assessment. 4 This is incorrect. The nurse needs to monitor the client's urinary output and maintain the drainage system according to standards and policy. This is not the assessment that will cause the nurse the most concern

The RN on an orthopedic unit is working with the LPN/LVN. Which instruction to the LPN/LVN from the RN is inappropriate? 1. Place the client with a left hip replacement one day ago onto the left side. 2. Assist a client with a knee replacement with continuous passive motion (CPM). 3. Insert an abduction pillow between the legs of a client with right hip replacement. 4. Use sterile technique to provide site care to tongs for a client with cervical traction.

Ans: 1. Place the client with a left hip replacement one day ago onto the left side. 1 This is correct. Generally, the RN will have orders not to turn the client onto the operative side during the immediate postoperative period. Instructions contradictive to this precedent are inappropriate. 2 This is incorrect. It is appropriate for the RN to instruct the LPN/LVN to assist a client who had a knee replacement with CPM. 3 This is incorrect. It is appropriate for the RN to instruct the LPN/LVN to insert an abduction pillow between the legs of a client with a hip replacement. 4 This is incorrect. It is within the scope of practice for the LPN/LVN to use sterile technique when provide site care to tongs for a client in cervical traction. The RN's instruction is appropriate.

The nurse is providing care for a client with an Ilizarov frame. Which entry will the nurse document in this client's medical record? 1. Rod, wires, and screw ring intact 2. Pedaling applied to outer cast edge 3. Weight suspended at 90 degrees 4. Abduction pillow used as instructed

Ans: 1. Rod, wires, and screw ring intact 1 This is correct. The Ilizarov frame is composed of metal rings on the outside of the limb with rods and wires that attach to those rings. The rods and wires also penetrate the skin to hold small fragments of bone in place for healing. 2 This is incorrect. Casts are not used with an Ilizarov frame. However, pedaling, which is over lapping the rough edge of the cast with tape to prevent irritation, is used when a client is casted. 3 This is incorrect. Weights are used for skeletal traction, not for a client with an Ilizarov frame. 4 This is incorrect. An abduction pillow is used after hip replacement surgery, not for a client with an Ilizarov frame.

The LPN/LVN works at a physical rehabilitation clinic. The LPN/LVN is aware of many clients who use assistive devices for mobilization. Which client is the LPN/LVN aware to be unsuitable for the use of a knee walker? 1. The client who is one week postoperative for a total knee replacement. 2. The client who had a below-the-knee amputation and is waiting for a prosthesis. 3. The client who is being treated for a prolonged and severe case of gout. 4. The client who has internal fixation for repair of a broken ankle and foot.

Ans: 1. The client who is one week postoperative for a total knee replacement. 1 This is correct. Clients with knee injuries or knee surgeries are not candidates for using a knee walker, because the person's weight rests on the knee and anterior portion of the lower leg. This client should use crutches or a walker to ambulate and protect the knee. 2 This is incorrect. A knee walker is suitable for a client with a below-the-knee amputation. This is a safe and comfortable mode of ambulation while the client is waiting for a prosthesis. 3 This is incorrect. Gout makes any pressure on the foot extremely painful; this client will be well suited for the use of a knee walker until the condition is resolved. 4 This is incorrect. Clients with ankle and foot injuries or surgeries are kept non-weight bearing during the healing period; therefore, the knee walker is a good choice for this client

The nurse is caring for a high school football player who is diagnosed with a serious sprain to the ankle. Which part of the anatomy does the nurse associate with this type of injury? 1. Torn ligaments 2. A fine crack in the anklebone 3. Injury to a long bone 4. Damage to cartilage tissue

Ans: 1. Torn ligaments 1 This is correct. A sprain is an injury to a joint that results in damage to muscles and ligaments. Severe sprains may cause ligaments to be completely torn. 2 This is incorrect. A fine crack in the anklebone is not involved in a sprain and is actually indicative of a fracture. 3 This is incorrect. Injury to a long bone is not typically involved in a sprain to the ankle. 4 This is incorrect. Damage to cartilage tissue is not involved in a sprain; this type of injury involves a joint.

The nurse is contributing to the plan of care for a patient with a cast. Which interventions should the nurse recommend including in the patient's plan of care? Select all that apply. 1. Use a new, unsharpened pencil to itch under the cast. 2. Observe for drainage. 3. Check for a malodorous smell. 4. "Petal" the edges of the cast if crumbling. 5. Perform neurovascular checks q4h for the first 24 hr.

Ans: 2, 3, 4 2. Observe for any drainage staining the cast, which would indicate infection or bleeding beneath the cast. 3. A malodorous smell may indicate there is an infection beneath the cast. 4. Place tape petals over the edges of the cast if they begin to crack or crumble over time. This technique also can be used to cover rough edges of the cast that may irritate the skin and cause breakdown