Med Surg Musculoskeletal Questions

A client is being discharged to home after application of a plaster leg cast. Which statement indicates that the client understands proper care of the cast? 1. "I need to avoid getting the cast wet." 2. "I need to cover the casted leg with warm blankets." 3. "I need to use my fingertips to lift and move my leg." 4. "I need to use something like a padded coat hanger end to scratch under the cast if it itches."

1. "I need to avoid getting the cast wet." A plaster cast must remain dry to keep its strength. The cast needs to be handled with the palms of the hands, not the fingertips, until fully dry; using the fingertips results in indentations in the cast and skin pressure under the cast. Air needs to circulate freely around the cast to help it dry; the cast also gives off heat as it dries. The client would never scratch under the cast because of the risk of altered skin integrity; the client may use a hair dryer on the cool setting to relieve an itch.

The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data would the nurse evaluate as the most favorable indication of resolution of the fat embolus? 1. Clear mentation 2. Minimal dyspnea 3. Oxygen saturation of 85% 4. Arterial oxygen level of 78 mm Hg

1. Clear mentation An altered mental state is an early indication of fat emboli; therefore, clear mentation is a good indicator that a fat embolus is resolving. Eupnea, not minimal dyspnea, is a normal sign. Arterial oxygen levels need to be 80 to 100 mm Hg. Oxygen saturation needs to be higher than 95%.

The nurse is caring for a client who has had spinal fusion, with insertion of hardware. The nurse would be most concerned with which assessment finding? 1. Temperature of 101.6° F (38.7° C) orally 2. Complaints of discomfort during repositioning 3. Old bloody drainage outlined on the surgical dressing 4. Discomfort during coughing and deep-breathing exercises

1. Temperature of 101.6° F (38.7° C) orally For this specific type of surgery, the nurse assesses the neurovascular status of the lower extremities, watches for signs and symptoms of infection, and inspects the surgical site for evidence of cerebrospinal fluid leakage (drainage is clear and tests positive for glucose). A mild temperature is expected after insertion of hardware, but a temperature of 101.6° F (38.7° C) should be reported. for the option that has the greatest deviation from normal. Options 2 and 4 are expected after surgery; although the nurse tries to minimize discomfort, the client is likely to have some discomfort, even with proper analgesic use. The words old and outlined in option 3 indicate that this is not a new occurrence. This leaves the temperature of 101.6° F (38.7° C), which is excessive and needs to be reported.

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse responds, knowing that which would most likely result from this improper crutch measurement? 1. A fall and further injury 2. Injury to the brachial plexus nerves 3. Skin breakdown in the area of the axilla 4. Impaired range of motion while the client ambulates

2. Injury to the brachial plexus nerves Crutches are measured so that the tops are two to three finger widths from the axillae. This ensures that the client's axillae are not resting on the crutch or bearing the weight of the crutch, which could result in injury to the nerves of the brachial plexus. Although the conditions in options 1, 3, and 4 can occur, they are not the most likely result from resting the axilla directly on the crutches.

The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states that they will report which early symptom of compartment syndrome? 1. Cold, bluish-colored fingers 2. Numbness and tingling in the fingers 3. Pain that increases when the arm is dependent 4. Pain that is out of proportion to the severity of the fracture

2. Numbness and tingling in the fingers The earliest symptom of compartment syndrome is paresthesia (numbness and tingling in the fingers). Other symptoms include pain unrelieved by opioids, pain that increases with limb elevation, and pallor and coolness to the distal limb. Cyanosis is a late sign. Pain that is out of proportion to the severity of the fracture, along with other symptoms associated with the pain, is not an early manifestation.

The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client? 1. Calcium level of 9.0 mg/dL (2.25 mmol/L) 2. Uric acid level of 9.0 mg/dL (540 mcmol/L) 3. Potassium level of 4.1 mEq/L (4.1 mmol/L) 4. Phosphorus level of 3.1 mg/dL (1.0 mmol/L)

2. Uric acid level of 9.0 mg/dL (540 mcmol/L) In addition to the presence of clinical manifestations, gout is diagnosed by the presence of persistent hyperuricemia. A normal value ranges from 2.7 to 8.5 mg/ dL (160-501 mcmol/L). In addition, the presence of uric acid in an aspirated sample of synovial fluid confirms the diagnosis.

The nurse is assessing the casted extremity of a client. Which sign is indicative of infection? 1. Dependent edema 2. Diminished distal pulse 3. Presence of a "hot spot" on the cast 4. Coolness and pallor of the extremity

3. Presence of a "hot spot" on the cast Signs of infection under a casted area include odor or purulent drainage from the cast or the presence of "hot spots," which are areas of the cast that are warmer than others. The primary health care provider needs to be notified if any of these are noted. Signs of impaired circulation in the distal limb include coolness and pallor of the skin, diminished distal pulse, and edema.

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

3. Thick, yellow drainage from the pin sites The nurse would monitor for signs of infection such as inflammation, purulent (thick white or yellow) 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 would correlate assessment findings with other clinical findings, such as fever, elevated white blood cell count, and changes in vital signs. Additionally, the nurse would compare any findings to baseline findings to determine if there were any changes.

The nurse is conducting health screening for osteoporosis. Which client is at greatest risk of developing this problem? 1. A 25-year-old client who runs 2. A 36-year-old client who has asthma 3. A 70-year-old client who consumes excess alcohol 4. A sedentary 65-year-old client who smokes cigarettes

4. A sedentary 65-year-old client who smokes cigarettes Risk factors for osteoporosis include gender, being postmenopausal, advanced age, a low-calcium diet, excessive alcohol intake, being sedentary, and smoking cigarettes. Longterm use of corticosteroids, anticonvulsants, and/or furosemide also increases the risk.

The nurse is admitting a client with multiple trauma injuries to the nursing unit. The client has a leg fracture and had a plaster cast applied. Which position would be best for the casted leg? 1. Elevated for 3 hours, then flat for 1 hour 2. Flat for 3 hours, then elevated for 1 hour 3. Flat for 12 hours, then elevated for 12 hours 4. Elevated on pillows continuously for 24 to 48 hours

4. Elevated on pillows continuously for 24 to 48 hours A plaster cast must remain dry to keep its strength. The cast needs to be handled with the palms of the hands, not the fingertips, until fully dry; using the fingertips results in indentations in the cast and skin pressure under the cast. Air needs to circulate freely around the cast to help it dry; the cast also gives off heat as it dries. The client would never scratch under the cast because of the risk of altered skin integrity; the client may use a hair dryer on the cool setting to relieve an itch.

A nurse is teaching a client how to manage an external fixation device upon discharge. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply) A. "I will clean the pins twice a day" B. "I will use a separate cotton swab for each pin" C. "I will report loosening of the pins to my doctor" D. "I will move my leg by lifting the device in the middle E. "I will report increased redness at the pin sites

A. "I will clean the pins more often is drainage from the pins increases" B. "I will use a separate cotton swab for each pin" C. "I will report loosening of the pins to my doctor" E. "I will report increased redness at the pin sites

A nurse is completing discharge teaching for a client who had a wound debridement for osteomyelitis. Which of the following information should the nurse include in the teaching? A. Antibiotic therapy should continue for 3 months B. Relief of pain indicates the infection is eradicated C. Airborne precautions are used during wound care D. Expect paresthesia distal to the wound

A. Antibiotic therapy should continue for 3 months

A home health nurse is teaching a client who has active TB and is following a medication regimen that includes a combination of isoniazid, rifampin, pyrazinamide, and ethambutol. Which of the following client statements indicates understanding? (SATA) A. "I can substitute one medication for another if I run out because they all fight infection. B. "I will wash my hands each time I cough." C. "I will wear a mask when I am in a public area." D. " I am glad I don't have to have any more sputum specimens." E. "I don't need to worry where I go once I start taking my medications."

B. "I will wash my hands each time I cough." C. "I will wear a mask when I am in a public area."

A nurse is caring for a client who has a chest tube and drainage system in place. The nurse observes that the client's chest tube was accidentally removed. Which of the following actions should the nurse take first? A. Place the tubing in sterile water to restore the water seal B. Apply sterile gauze to the insertion site C. Place tape around the insertion site D. Assess the client's respiratory status

B. Apply sterile gauze to the insertion site Using ABC priority framework, the application of a sterile gauze to the site should be the first action for the nurse to take. This allows the air to escape and reduces the risk of the tension pneumothorax.

A nurse in the emergency department is planning care for a client who has a right hip fracture. Which of the following immobilization devices should the nurse anticipate in the plan of care? A. Skeletal traction B. Buck's traction C. Halo traction D. Bryant's traction

B. Buck's traction -Buck's traction- a temporary immobilization device applied to client who has femur or hip FX to decrease muscle spasm & immobilize the affected extremity until surgery is performed. -Skeletal traction- applied surgically to a long bone (femur or tibia) and cervical spine. Not for HiP FX -Halo TX- immobilizes the cervical spine with a cervical spine FX occurs - Bryants Traction- used for congenital hip dislocation in children

A nurse is assessing a client who has a chest tube and drainage system in place. Which of the following are expected findings? (Select all that apply) A. Continuous bubbling in the water seal chamber B. Gentle constant bubbling in the suction control chamber C. Rise and fall in the level of water in the water seal chamber with inspiration D. Exposed sutures without dressing E. Drainage system upright at chest level

B. Gentle constant bubbling in the suction control chamber C. Rise and fall in the level of water in the water seal chamber with inspiration Gentle bubbling in the suction control chamber is an expected finding as air is being removed. A rise and fall of the fluid level in the water seal chamber upon inspiration and expiration indicate that the drainage system is functioning properly.

A nurse is caring for a client who has a new diagnosis of TB and has been placed on a multimedication regimen. Which of the following instructions should the nurse give the client r/t ethambutol? A. "Your urine can turn a dark orange." B. "Watch for a change in the sclera of your eyes." C. "Watch for any changes in vision." D. "Take vitamin B6 daily."

C. "Watch for any changes in vision."

A nurse is preparing to administer a new prescription for isoniazid (INH) to a light-skinned client who has TB. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication? A. yellowing on the skin B. pain in joints C. tingling in hands D. loss of appetite

C. tingling in hands (adverse effect)

A nurse is assisting a provider with the removal of a chest tube. Which of the following should the nurse instruct the client to do? A. Lie on his left side B. Use the incentive spirometer C. Cough at regular intervals D. Perform the Valsalva maneuver

D. Perform the Valsalva maneuver The client should be instructed to take a deep breath, exhale, and bear down as the chest tube is being removed. This increases intrathoracic pressure and reduces the risk of an air embolism

The nurse is educating a PT who will have external fixation for RX of a compound tibial fracture. What information does the nurse include in the teaching session? a. "the device allows for early ambulation" b. "the device is sterile; there is no danger of infection" c. "the device is a substitute therapy for a cast d. "the advantage of the device is rapid bone healing"

a. "the device allows for early ambulation"

the home health nurse reads in the documentation that the PT has volkmann's contracture that occurred several years ago. which assessment is the nurse most likely to perform to assess this condition? a. ability to perform ADL's b. presence of distal pulses c. ability to climb the stairs d. need for pain meds

a. ability to perform ADL's

An older client was admitted 2 days ago with a fractured hip. Your assessment notes the client to be confused, have tachypnea, and be restless. What is your first action? a. administer 02 b. notify MD c. slow the lv flow rate a. DC the pain med

a. administer 02 high risk of FE- can be fatal, risk of cerebral damage

The purpose of skeletal Tx is to: a. realign the bone b. prevent low back pain c. decrease muscles d. prevent skin injury from the fracture

a. realign the bone pins & screws inserted

the nurse is instructing a teenage PT who has a tibia-fibula FX that was treated w/ internal fixation and a long cast. He is anxious to know when the cast will be removed so that he can resume football practice. Which statement by the PT indicates a need for additional teaching? a. there's a possibility that the cast could be removed in 4 weeks b. the plates and screws reduce the length of time i'll be in the cast c. the cast could remain in place as long as 6 weeks d. i'll use the crutches for 2 weeks, and then the cast will be removed

d. i'll use the crutches for 2 weeks, and then the cast will be removed

a PT comes to the emergency department after slipping on some chalk in her classroom. She did not "have a hard fall" and was able to walk with the assistance of one of her students. What type of FX is this PT most likely to have? a. compression b. displaced c. impacted d. incomplete

d. incomplete

The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up. A leg appears fractured. Which intervention would the nurse take? 1. Try to reduce the fracture manually. 2. Assist the victim to get up and walk to the sidewalk. 3. Leave the victim for a few moments to call an ambulance. 4. Stay with the victim and encourage the victim to remain still.

4. Stay with the victim and encourage the victim to remain still. With a suspected fracture, the victim is not moved unless it is dangerous to remain in that spot. The nurse would remain with the victim and have someone else call for emergency help. A fracture is not reduced at the scene. Before the victim is moved, the site of fracture is immobilized to prevent further injury.

A nurse is providing information about TB to a group of clients at a local community center. Which of the following manifestations should the nurse include? (SATA) A. persistent cough B. weight gain C. fatigue D. night sweats E. purulent sputum

A. persistent cough C. fatigue D. night sweats E. purulent sputum

which nursing intervention is best to prevent increased pain in a PT experiencing PLP? a. handle the residual limb carefully when assessing the site or changing the dressing b. advise the PT that the sensation is temporary and will diminish over time. c. remind the PT that the part is not really there, so the pain is not real. d. encourage the PT to mourn the loss of the body part and express grief.

a. handle the residual limb carefully when assessing the site or changing the dressing

A client with a crush injury to the right lower leg c/a numbness & tingling of the affected extremity. Skin of right leg is pale and the pedal pulse is weak. What is your best response? a. notify MD b. loosen the dressing c. increase the lv flow rate d. document the finding as the only action

a. notify MD suspected compartment syndrome

Which skin flap finding indicates the amputated limb has adequate tissue per fusion? a. skin flap is pink & warm b. skin flap color is red & cool c. skin flap color is dark pink & very warm d. skin flap darker in comparison to rest of body

a. skin flap is pink & warm good perfusion

the nurse is caring for a PT in Buck's (skin traction). Which task is best to delegate to UAP (with supervision)? a. turning and repositioning b. inspecting heels and sacral area c. asking the PT about muscle spasms d. adjusting the weights on the apparatus

a. turning and repositioning

the nurse is caring for a patient with an open FX. which intervention does the nurse perform to prevent infection of the FX? a. use aseptic technique for dressing changes and wound irrigation b. culture the wound and obtain an order for antibiotics c. place the PT in contact isolation and wear sterile gloves d. place the PT on neutropenic precautions and perform hand hygiene

a. use aseptic technique for dressing changes and wound irrigation

Which client is at most risk of infection after a fx? A client with: a. fractured clavicle b. an open fx of the tibia c. simple fx of the wrist d. compression fx of a vertebrae

b. an open fx of the tibia break in skin, high risk for infection

the nurse's neighbor comes running over because her husband "cut his finfer off with a power saw." What is the priority nursing action? a. examine the amputation site b. assess for airway or breathing problems c. elevate the hand above the heart d. assess the severed finger

b. assess for airway or breathing problems

a 30-year-old PT who is hospitalized for repair of a fractured tibia and fibula reports SOB. Which complication related to the injury might the PT be experiencing? a. acute renal failure b. fat embolism c. acute compartment syndrome d. pneumonia

b. fat embolism

the nurse is caring for several orthopedic PT's who are in different types of traction. what should the nurse do to assess the traction equipment? a. inspect all ropes, knots, and pulleys once q 24 hours b. inspect ropes and knots for fraying or loosening q 8 to 12 hours c. check the amount of weight being used against the prescribed weight d. check if the ropes have been changed or cleaned within the past 48 hours f. reduce or adjust the weights if the PT is having excessive pain

b. inspect ropes and knots for fraying or loosening q 8 to 12 hours c. check the amount of weight being used against the prescribed weight d. check if the ropes have been changed or cleaned within the past 48 hours

You are caring for a client with a suspected pelvic fx. What complication of this fx do you monitor this client for? a. infection b. delayed union c. hypovolemic shock d. impaired skin integrity

c. hypovolemic shock bleeding is #1- fractured pelvis= internal organ damage- which can produce bleeding-- monitor VS, LOC, & Color

A patient who tripped and fell down several stairs reports having heard a popping sound and fears that she has broken her ankle. How does the nurse initially assess for fracture in this patient? a) Measuring the circumference of the distal leg b) Gently moving the ankle through the full range of motion c) Inspecting for crepitus and skin color d. observes for deformity or misalignment

d) Observing for deformity or misalignment

Which client is at most risk for deep vein thrombosis? a. 50 yo female with fractured ankle who takes aspirin for rheumatoid Arthritis b. 25 yo male athlete with a fractured clavicle c. 40 yo female diabetic with fractured ribs d. 60 yo male smoker with a fractured pelvis

d. 60 yo male smoker with a fractured pelvis smoking, obesity, CVD, venous stasis, COPD

What complication is possible with a body cast? a. infection b. urinary retention c. skin excoriation d. intestinal obstruction

d. intestinal obstruction w/ body cast- looking for cast syndrome from pressure

The nurse applies bandages to a PT's residual limb to help shape and shrink the limb for a prosthesis. What is the proper technique for the nurse to use? a. reapply the bandages q 8 hours or more often if they become loose b. use a proximal-to-distal direction when wrapping c. use soft, flexible bandage material & pad the area w/ gauze d. use a figure 8 wrapping method to prevent restriction of blood flow

d. use a figure 8 wrapping method to prevent restriction of blood flow

A client is complaining of low back pain that radiates down the left posterior thigh. The nurse would ask the client if the pain is worsened or aggravated by which factor? 1. Bed rest 2. Ibuprofen 3. Bending or lifting 4. Application of heat

3. Bending or lifting Low back pain that radiates down one leg (sciatica) is consistent with herniated lumbar disc. The nurse assesses the client to see whether the pain is aggravated by events that increase intraspinal pressure, such as bending, lifting, sneezing, and coughing, or by lifting the leg straight up while supine (straight leg-raising test). Bed rest, heat (or sometimes ice), and nonsteroidal antiinflammatory drugs (NSAIDs) usually relieve back pain.

A nurse is assessing a client who has a casted compound fracture of the femur. Which of the following finding's is a manifestation of a fat embolous? a. altered mental status b. reduced bowel sounds c. swelling of the toes distal to the injury d. pain with passive movement of the foot distal to the injury

a. altered mental status #1 sign of FE= confusion -reduced bowel sounds= adverse effect of opioid narcotics & constipation -swelling of toes= reduced circulation, cast may be too tight- elevate extremity & apply ice -pain with passive movement= expected, hOWEVER, severe pain unrelieved by narcotics is a finding of compartment syndrome

the nurse is caring for a patient with skeletal pins that have been placed for traction. what does the nurse expect for the first 48 hours? a. clear fluid drainage weeping from the pin insertion site b. some bloody drainage at the site but very minimal c. swelling at the site with tenderness to gentle touch d. dressings around the pin sites to be dry and intact

a. clear fluid drainage weeping from the pin insertion site

the nursing student is assisting with the care of a PT w/ musculoskeletal pain related to soft tissue injury and bone disruption. The student sees that the PT has a prn order for pain medication. What does the student do first to decide when to give the pain medication? a. ask the health care provider to give specific parameters b. ask the primary nurse or the charge nurse for advice c. ask the PT about the activities that increase the pain. d. ask the nursing instructor for help interpreting the order.

c. ask the PT about the activities that increase the pain.

the nurse is caring for a PT with a plaster splint applied to the ankle. the PT received oral pain medication at 0900. At 1100, the PT reports that the pain is getting worse, not better. What is the nurse's priority action? a. give the PT IV pain med b. reposition the extremity on a pillow & place an ice pack c. assess the pulses and skin temp distal to the splint d. call the HCP to report the increasing pain

c. assess the pulses and skin temp distal to the splint

the older PT has a fracture that has failed to heal. Which fracture complication best describes this situation? a. malunion b. avascular necrosis c. nonunion d. crush syndrome

c. nonunion

which PT has the greatest risk for developing avascular necrosis? a. "little person" with a congenital bone deformity b. woman with osteoporosis and a colles' fracture c. older adult with a hip fracture d. teenager w/ a dislocated shoulder

c. older adult with a hip fracture

the UAP is assisting the orthopedic cast technician to cut a window in a PT's cast. what does the nurse instruct the UAP to do? a. check the distal pulses after the window is cut b. clean up and dispose of all casting debris c. inform the PT that the procedure is painless d. save the cutout cast piece so it can be taped in place

d. save the cutout cast piece so it can be taped in place

The nurse has given the client instructions about crutch safety. Which statements indicate that the client understands the instructions? Select all that apply. 1. "I would not use someone else's crutches." 2. "I need to remove any scatter rugs at home." 3. "I can use crutch tips even when they are wet." 4. "I need to have spare crutches and tips available." 5. "When I'm using the crutches, my arms need to be completely straight.

1. "I would not use someone else's crutches." 2. "I need to remove any scatter rugs at home." 4. "I need to have spare crutches and tips available." The client needs to use only crutches measured for the client. When assessing for home safety, the nurse ensures that the client knows to remove any scatter rugs and to avoid walking on highly waxed floors. The tips need to be inspected for wear, and spare crutches and tips should be available if needed. Crutch tips should remain dry. If crutch tips get wet, the client needs to dry them with a cloth or paper towel. When walking with crutches, both elbows need to be flexed not more than 30 degrees when the palms are on the handle.

Which cast care instructions would the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply. 1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated. 4. Expect tingling and numbness in the extremity. 5. Use a hair dryer set on a warm to hot setting to dry the cast. 6. Use a soft, padded object that will fit under the cast to scratch the skin under the cast.

1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated. A plaster cast takes 24 to 72 hours to dry (synthetic casts dry in 20 minutes). The cast and extremity need to be elevated to reduce edema if prescribed. A wet cast is handled with the palms of the hand until it is dry, and the extremity is turned (unless contraindicated) so that all sides of the wet cast will dry. A cool setting on the hair dryer can be used to dry a plaster cast (heat cannot be used on a plaster cast because the cast heats up and burns the skin). The cast needs to be kept clean and dry, and the client is instructed not to stick anything under the cast because of the risk of breaking skin integrity. The client is instructed to monitor the extremity for circulatory impairment, such as pain, swelling, discoloration, tingling, numbness, coolness, or diminished pulse. The primary health care provider is notified immediately if circulatory impairment occurs.

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers an analgesic, with little relief. Which problem may be causing this pain? 1. Infection under the cast 2. The anxiety of the client 3. Impaired tissue perfusion 4. The recent occurrence of the fracture

3. Impaired tissue perfusion Most pain associated with fractures can be minimized with rest, elevation, application of cold, and administration of analgesics. Pain that is not relieved by these measures needs to be reported to the primary health care provider because pain unrelieved by medications and other measures may indicate neurovascular compromise. Because this is a new closed fracture and cast, infection would not have had time to set in. Intense pain after casting is normally not associated with anxiety or the recent occurrence of the injury. Treatment following the fracture should assist in relieving the pain associated with the injury.

The nurse is caring for a client who had an above-knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which immediate action would the nurse take? 1. Apply ice to the site. 2. Call the primary health care provider (PHCP). 3. Rewrap the residual limb with an elastic compression bandage. 4. Apply a dry, sterile dressing, and elevate the residual limb on one pillow.

3. Rewrap the residual limb with an elastic compression bandage. If the client with an amputation has a cast or elastic compression bandage that slips off, the nurse must wrap the residual limb immediately with another elastic compression bandage. Otherwise, excessive edema will form rapidly, which could cause a significant delay in rehabilitation. If the client had a cast that slipped off, the nurse would have to call the PHCP so that a new one could be applied. Elevation on one pillow is not going to impede the development of edema greatly once compression is released. Ice would be of limited value in controlling edema from this cause. If the PHCP were called, the prescription likely would be to reapply the compression dressing anyway.

The nurse has given instructions to a client who sustained a ligament injury who is returning home after knee arthroscopy. Which statement by the client indicates that the instructions are understood? 1. "I can resume regular exercise tomorrow." 2. "I can't eat food for the remainder of the day." 3. "I need to stay off the leg entirely for the rest of the day." 4. "I need to report a fever, redness around my incisions, or persistent drainage to my health care provider."

4. "I need to report a fever, redness around my incisions, or persistent drainage to my health care provider." After arthroscopy, the client usually can walk carefully on the leg once sensation has returned. The client is instructed to avoid strenuous exercise for the length of time prescribed by the surgeon. The client may resume the usual diet. Signs and symptoms of infection need to be reported to the primary health care provider. Test-Taking Strategy: Focus on th

A client with a hip fracture asks the nurse what is involved with Buck's (extension) traction, which is being applied before surgery. The nurse would provide which information to the client? 1. Allows bony healing to begin before surgery and involves pins and screws 2. Provides rigid immobilization of the fracture site and involves pulleys and wheels 3. Lengthens the fractured leg to prevent severing of blood vessels and involves pins and screws 4. Provides comfort by reducing muscle spasms, provides fracture immobilization, and involves pulleys and wheels

4. Provides comfort by reducing muscle spasms, provides fracture immobilization, and involves pulleys and wheels Buck's (extension) traction is a type of skin traction often applied after hip fracture before the fracture is reduced in surgery. Traction reduces muscle spasms and helps immobilize the fracture. Traction does not allow for bony healing to begin or provide rigid immobilization. Traction does not lengthen the leg for the purpose of preventing blood vessel severance. This type of traction involves pulleys and wheels, not pins and screws.

A client with diabetes mellitus has had a right below-knee amputation. Given the client's history of diabetes mellitus, which complication is the client at most risk for after surgery? 1. Hemorrhage 2. Edema of the residual limb 3. Slight redness of the incision 4. Separation of the wound edges

4. Separation of the wound edges Clients with diabetes mellitus are more prone to wound infection, wound separation, and delayed wound healing because of the disease. Postoperative hemorrhage and edema of the residual limb are complications in the immediate postoperative period that apply to any client with an amputation. Slight redness of the incision is considered normal, as long as the incision is dry and intact

A nurse is planning care for a client following the insertion of a chest tube and drainage system. Which of the following should be included in the plan of care? (Select all that apply) A. Encourage the client to cough every 2 hours B Check for continuous bubbling in the suction chamber C. Strip the drainage tubing every 4 hours D. Clamp the tube once a day E. Obtain a chest x ray

A. Encourage the client to cough every 2 hours B. Check for continuous bubbling in the suction chamber E. Obtain a chest x ray Cough every 2 hours to promote oxygenation and lung reexpansion. Check for continuous bubbling in the suction chamber to verify that suction is being maintained at an appropriate level. A chest x ray is obtained following the procedure to verify chest tube placement.

A nurse preparing to care for a client following chest tube placement. Which of the following items should be available in the client's room? (Select all that apply) A. Oxygen B. Sterile water C. Enclosed hemostat clamps D. Indwelling urinary catheter E. Occlusive dressing

A. Oxygen B. Sterile water C. Enclosed hemostat clamps E. Occlusive dressing Oxygen should be readily available in case the client develops respiratory distress following chest tube placement. If the chest tube becomes disconnected, the end of the tubing should be placed in sterile water to restore the water seal. Hemostat clamps should be available for the nurse to use to check air leaks. Immediately place an occlusive dressing over the chest tube insertion site if becomes disconnected. This allows air to escape and reduces the risk for a tension pneumothorax.

the nurse is reviewing the Lab results of a PT who may have FE syndrome. which abnormal laboratory findings accompany this condition? select al that apply. a. decreased PAO2 level ( often < 60mmHg) b. increased Erythrocyte sed rate c. decreased calcium levels d. decreased RBC and platelet counts e. increased serum level of lipids f. increased serum K+ levels

a. decreased PAO2 level ( often < 60mmHg) b. increased Erythrocyte sed rate c. decreased calcium levels d. decreased RBC and platelet counts e. increased serum level of lipids

You are a home care RN visiting a diabetic client with a new cast on the arm for a fractured elbow. You find the client's fingers pale, cool, and slightly edematous. What is your best first action? a. elevate the arm above the level of the heart b. withhold the next dose of insulin c. apply heat to the affected hand d. bivalve the cast

a. elevate the arm above the level of the heart elevate first to promote circulation-- then check again, if warm, then cast is OK, if not-- still cold, call MD

A nurse is a assessing a client who had an external fixation device applied 2 hr ago for a fracture of the left tibia and fibula. Which of the following findings is a manifestation of compartment syndrome? Select all that apply. a. intense pain when the client's left foot is passively moved b. capillary refill of 3 sec on the client's left toes c. hard, swollen muscle in the client's left leg d. burning and tingling of the client's left foot e. client report of minimal pain relief following a second dose of opioid medication

a. intense pain when the client's left foot is passively moved c. hard, swollen muscle in the client's left leg d. burning and tingling of the client's left foot e. client report of minimal pain relief following a second dose of opioid medication

the nurse is caring for a PT w/ an AKA. to prevent hip flexion contractures, how does the nurse position the PT? a. supine position w/ the residual limb elevated on a pillow b. prone position q 3-4 hours for 20-30 minute periods c. supine position w/ an abduction pillow placed between the legs d. HOB elevated 30 degrees w/ bandage snug around the limb

b. prone position q 3-4 hours for 20-30 minute periods

in the emergency care of a PT with a FX, which action does the nurse implement first? a. check the neurovascular status of the area distal to the injury: 6 P's- pain, parastethsias, pallor, polar, pulselessness, paralysis b. remove or cut the PT's clothing to inspect the affected area while supporting the injured area above and below the injury c. elevate the affected area on pillows, apply an ice pack that is wrapped to protect the skin, and obtain an order for pain medication d. immobilize the extremity by splinting; include joints above and below the fracture site. recheck circulation after splinting

b. remove or cut the PT's clothing to inspect the affected area while supporting the injured area above and below the injury

a PT is informed by the HCP that a fiberglass cast must be applies to the lower extremity. What does the nurse teach the PT about the procedure before the cast is applied? a. the stockinette should be changes 1x a week b. the cast material will dry and become rigid in a few minutes c. the cast will increase your risk for skin breakdown d. the fiberglass is not waterproof, so avoid getting it wet SYNTHETIC

b. the cast material will dry and become rigid in a few minutes

A PT w/ a leg cast denies pain; toes are pink, capillary refill is brisk and toes move freely, and the leg is elevated with an ice pack. Six hours later, the PT reports worsening pain unrelieved by medication. The PT's toes are cool, and pulse is difficult to detect. What does the nurse suspect is occurring with this PT? a. crush syndrome b. FE syndrome c. acute compartment syndrome d. facititis

c. acute compartment syndrome

An older adult client has been admitted with a hip fracture. Approximately 20 hours after injury, the PT develops signs & SX that the nurse recognizes as early indicator of FE syndrome. Which signs & SX is the PT displaying? a. severe respiratory distress b. significant tachycardia c. altered mentation d. petechial rash over the neck

c. altered mentation

A PT in a cast reports a painful "hot spot" underneath the cast, and the nurse notices an unpleasant odor. Which intervention is the nurse most likely to perform first? a. offer the PT with a prn pain med b. help the PT w/ hygiene around the cast c. take the PT's temp & other vital signs d. call the orthopedic technician to change the cast

c. take the PT's temp & other vital signs

A 25- year old PT sustained a crush injury to his right upper extremity and right lower extremity when heavy equipment fell on him. Signs & SX of hypovolemia and compartment syndrome are present. Management of care for this PT will focus on preventing which complication? a. acute liver failure b. ischemic heart failure c. respiratory failure d. myoglobinuric renal falure

d. myoglobinuric renal falure

Skin around the skeletal traction pin site is swollen, red, and crusty with drainage. What is your best action? a. decrease the tx weight b. apply a new dressing c. document the finding as the only action d. notify the MD

d. notify the MD possible infection- osteomyletis risk- notify MD

A PT w/ a lower extremity injury is being treated with external fixation. which nursing assessment is of particular concern in the care of a PT w/ this type of system? a. maintaining a 30-degree flexed position of the knee b. measuring the weights used for countertraction c. observing the PT's ability to adjust the clickers d. observing the points of entry of the pins and wires

d. observing the points of entry of the pins and wires

You are caring for a client with a fractured femur. What factor in the client's history may impede healing of the fracture? a. a sedentary lifestyle b. a hx of smoking c. oral contraceptive use d. peripheral vascular disease (PVD)

d. peripheral vascular disease (PVD) impaired blood flow, decreased arterial circulation to bones-- so bone recieves less O2

A nurse is assisting a provider with the removal of a chest tube. Which of the following should the nurse instruct the client to do? a. instruct the client to lie prone w/ arms by his side b. complete a surgical checklist on the client c. remind the client that there is minimal discomfort during the removal process d. place an occlusive dressing over the site once the tube is removed

d. place an occlusive dressing over the site once the tube is removed -place occlusive dressing and observe the site for drainage -removal of chest tube can be painful - tubes are removed by provider at the bedside - position client assumes during removal determines location of insertion site. must ensure arms are not covering the ribs on site of insertion.

an older PT w/ a hip fracture has prolonged immobility related to difficulties in performing the prescribed weight-bearing exercises. based on FX pathophysiology and the PT's abilities, which condition could the PT develop? a. osteomyelitis b. internal derangement c. neuroma d. pulmonary embolism

d. pulmonary embolism