prep U Chapter 37

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? "A belt will go around my pelvis and weights will be attached." "I will wear a boot with weights attached." "Metal pins will go through my skin to the bone." "The traction can be removed once a day so I can shower."

C In skeletal traction, metal rods or pins are used to apply continuous traction directly to the bone. Weights are used to apply the traction. Casts, external fixators, or splints are used when the traction is discontinued.

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Fahrenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which complication? Urinary retention Osteomyelitis Hypovolemic shock Atelectasis

C Indicators of hypovolemic shock include a heart rate greater than 100 beats per minute, a blood pressure less than 90/60 mm Hg, and urine output less than 30 ml per hour.

When is it advisable for the nurse to apply heat to a sprain or a contusion? Only after a week Immediately After 2 days Do not apply at all

C It is advisable to apply heat on a sprain or a contusion 2 days after a sprain or a contusion has occurred. This is because after 2 days swelling is not likely to increase and as a result heat application reduces pain and relieves local edema by improving circulation. Delaying the application of heat prolongs the pain and increased the risk of local edema.

A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin? In 2 to 3 months, after normal activities are resumed In about 4 to 5 weeks, after new bone is well established As soon as tolerated, after a reasonable period of immobilization In 2 to 3 weeks, when callus ossification prevents easy movements of bony fragments

C Many impacted fractures of the surgical neck of the humerus are not displaced and do not require reduction. The arm is supported and immobilized by a sling and swathe that secure the supported arm to the trunk (Fig. 43-10). Limitation of motion and stiffness of the shoulder occur with disuse. Therefore, pendulum exercises begin as soon as tolerated by the patient. In pendulum or circumduction exercises, the physical therapist instructs the patient to lean forward and allow the affected arm to hang in abduction and rotate. These fractures require approximately 4 to 10 weeks to heal, and the patient should avoid vigorous arm activity for an additional 4 weeks. Residual stiffness, aching, and some limitation of ROM may persist for 6 months or longer (NAON, 2007).

The orthopedic surgeon has prescribed balanced skeletal traction for a client. What advantage is conferred by balanced traction? Balanced traction can be applied at night and removed during the day. Balanced traction facilitates bone remodeling in as little as 6 days. Balanced traction allows for greater client movement and independence than other forms of traction. Balanced traction is portable and may accompany the client's movements.

C Often, skeletal traction is balanced traction, which supports the affected extremity, allows for some client movement, and facilitates client independence and nursing care while maintaining effective traction. It is not portable, however, and it cannot be removed. Bone remodeling takes longer than 6 days.

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

C Open fractures are graded according to the following criteria (Schaller, 2012): Grade I is a clean wound less than 1 cm long. Grade II is a larger wound without extensive soft tissue damage or avulsions. Grade III is highly contaminated and has extensive soft tissue damage. It may be accompanied by traumatic amputation and is the most severe.

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

C Pathologic fractures can occur without the trauma of a fall. An avulsion fracture results in a fragment of bone being pulled away by a ligament or tendon and its attachment. A greenstick fracture presents as one side of the bone being broken and the other side being bent. A compound fracture involves damage to the skin or mucous membranes.

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan? Maintaining the client on complete bed rest Applying heat to the stump as the client desires Elevating the stump for the first 24 hours Removing the pressure dressing after the first 8 hours

C Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. Bed rest isn't indicated and could predispose the client to complications of immobility. Heat application would be inappropriate because it promotes vasodilation, which may cause hemorrhage and increase pain. The initial pressure dressing usually remains in place for 48 to 72 hours after surgery.

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

C The client's description of blunt trauma by a baseball bat and localized pain in conjunction with swelling and ecchymosis would most likely suggest a contusion. A fracture would be manifested by pain, loss of function, deformity, swelling, and spasm. A sprain would be manifested by pain and swelling; ecchymosis may appear later. A strain is characterized by inflammation, local tenderness, and muscle spasms.

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure? Replacement of one of the articular surfaces of a joint Incision and diversion of the muscle fascia Excision of damaged joint fibrocartilage Replacement of knee with artificial joint

C The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint. Total joint arthroscopy is the replacement of a joint with synthetic material.

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

C The nurse should apply a tourniquet in the event of postsurgical hemorrhage. Elevating the limb and applying sterile gauze are likely insufficient to stop the hemorrhage. The nurse should attempt to control the immediate bleeding before contacting the surgeon.

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? Have the patient extend both hands while the nurse compares the volume of both radial pulses. Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes.

C The nurse should assess for pain on passive flexion of each foot, which could indicate deep vein thrombosis.

A client with a traumatic amputation of the right lower leg is refusing to look at the leg. Which action by the nurse is most appropriate? Request a referral to occupational therapy. Encourage the client to perform range-of-motion (ROM) exercises to the right leg. Provide feedback on the client's strengths and available resources. Provide wound care without discussing the amputation.

C The nurse should encourage the client to look at, and assist with, care of the residual limb. Providing feedback on the client's strengths and resources may allow the client to start to adapt to the body image and lifestyle change. The nurse should also allow time for the client to discuss their feelings related to the amputation. Requesting a referral to occupational therapy and encouraging the client to perform ROM exercises are appropriate but do not address the emotional aspect of losing an extremity.

A nurse is caring for a client in skin traction. In order to prevent bony fragments from moving against one another, the nurse should caution the client against performing what action? Shifting one's weight in bed Bearing down while having a bowel movement Turning from side to side Coughing without splinting

C To prevent bony fragments from moving against one another, the client should not turn from side to side; however, the client may shift position slightly with assistance. Bearing down and coughing do not pose a threat to bone union.

A client broke his arm in a sports accident and required the application of a cast. Shortly following application, the client reported an inability to straighten his fingers and was subsequently diagnosed with Volkmann contracture. What pathophysiologic process caused this complication? Simultaneous pressure on the ulnar and radial nerves Uncontrolled muscle spasms in the client's forearm Obstructed arterial blood flow to the forearm and hand Irritation of Merkel cells in the client's skin surfaces

C Volkmann contracture occurs when arterial blood flow is restricted to the forearm and hand and results in contractures of the fingers and wrist. It does not result from nerve pressure, skin irritation, or spasms.

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? Ropes freely moving over pulleys Pulleys without evidence of the obstruction Weights hanging and touching the floor Body aligned opposite to line of traction pull

C When checking traction equipment, the weights should be freely hanging. Weights that touch the floor require the nurse to intervene. The body should be aligned in an opposite line to the pull of the traction. The ropes should be freely moving over unobstructed pulleys.

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

D A Colles fracture occurs in the distal radius. Falling with outstretched arms and hands may increase the risk of this type of fracture. A spiral fracture results from a twisting movement. A greenstick fracture is a bent and incomplete fracture commonly seen in children. A compound fracture results in the bone extending through the skin.

A hip spica cast: is a short or long leg cast reinforced for strength. encircles the trunk. extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed. encloses the trunk and a lower extremity.

D A hip spica cast encloses the trunk and a lower extremity. A double hip spica cast includes both legs. A body cast encircles the trunk. A walking cast is a short or long leg cast reinforced for strength. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.

A client comes to the emergency department and it is found that the client's radial head is partially dislocated. What is this partially dislocated radial head documented as? Volkmann's contracture Sprain Compartment syndrome Subluxation

D A partial dislocation is referred to as a subluxation. A Volkmann's contracture is a claw like deformity that results from compartment syndrome or obstructed arterial blood flow to the forearm and hand. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space and affects nerve innervation, leading to subsequent palsy. A sprain is injury to the ligaments surrounding the joint.

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

D After fracture of long bones or pelvic bones, or crush injuries, fat emboli frequently form. Fat embolism syndrome (FES) occurs when fat emboli cause morbid clinical manifestations. The classic triad of clinical manifestations of FES include hypoxemia, neurologic compromise, and a petechial rash (NAON, 2007), although not all signs and symptoms manifest at the same time (Tzioupis & Giannoudis, 2011). The typical first manifestations are pulmonary and include hypoxia and tachypnea.

A nurse would most likely expect the need for open reduction for a client with which of the following? Little bone separation Closed fracture Soft tissue free of bone ends Joint fracture

D An open reduction is required when soft tissue is caught between the ends of the broken pieces of bone, the bone has a wide separation, open fractures are evident, comminuted fractures are present, and the patella or other joints are fractured. It is also done when wound debridement or internal fixation is needed.

When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction? Apply heat to the fracture site. Use crutches for 1 week. Perform ankle dorsiflexion three times per day. Apply ice to the fracture site.

D Applying ice to the injury site soon after an injury causes vasoconstriction, helping to relieve or prevent swelling and bleeding. Applying heat to the fracture site may increase swelling and bleeding. Ankle dorsiflexion has no therapeutic use after a toe fracture. It's unlikely the client would need crutches after a toe fracture.

A nurse is reviewing a client's activities of daily living prior to discharge from total hip replacement. The nurse should identify what activity as posing a potential risk for hip dislocation? Straining during a bowel movement Transferring from a sitting to standing position Lifting items above shoulder level Bending down to put on socks

D Bending to put on socks or shoes can cause hip dislocation. None of the other listed actions poses a serious threat to the integrity of the new hip.

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse? "CPM delivers analgesic agents directly into the joint." "CPM strengthens the muscles of the leg." "CPM prevents injury by limiting flexion of the knee." "CPM increases range of motion of the joint."

D CPM increases circulation and range of motion of the knee joint.

When the client who has experienced trauma to an extremity reports severe burning pain, vasomotor changes, and muscles spasms in the injured extremity, the nurse recognizes that the client is likely demonstrating signs of avascular necrosis of bone. heterotrophic ossification. a reaction to an internal fixation device. complex regional pain syndrome.

D Complex regional pain syndrome is frequently chronic and occurs most often in women. Avascular necrosis is manifested by pain and limited movement. Pain and decreased function are the prime indicators of reaction to an internal fixation device. Heterotrophic ossification causes muscular pain and limited muscular contraction and movement.

A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse? "I am sorry. We ran out of pillows. I can elevate it on a few blankets." "Elevating the extremity may increase your chances of compartment syndrome." "You need to turn yourself side to side. If your leg is on a pillow, you would not be able to do that." "Elevating the leg might lead to a flexion contracture."

D Elevating the residual limb on a pillow may lead to a flexion contracture; this could jeopardize the client's ability to use a prosthesis. The client does need to turn to both sides but might still be able to do it with the extremity elevated. Elevating the extremity would not increase the risk for compartment syndrome. The limb should not be elevated on pillows or blankets.

A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? Performing passive range-of-motion (ROM) exercises on the client's legs once each shift Turning the client from side to side every 2 hours Maintaining the client in semi-Fowler's position Keeping a pillow between the client's legs at all times

D Explanation: After open reduction with internal fixation, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period, because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After open reduction with internal fixation, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.

Which factor inhibits fracture healing? Age of 35 years Immobilization of the fracture Increased vitamin D and calcium in the diet History of diabetes

D Factors that inhibit fracture healing include diabetes, smoking, local malignancy, bone loss, extensive local trauma, age greater than 40, and infection. Factors that enhance fracture healing include proper nutrition, vitamin D and calcium, exercise, maximum bone fragment contact, proper alignment, and immobilization of the fracture.

An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement? The client's pain will increase until the joint is realigned. The longer the joint is displaced, the more difficult it is to get it back in place. Dislocation can become permanent if the process of bone remodeling begins. Avascular necrosis may develop at the site if it is not promptly resolved.

D If a dislocation or subluxation is not reduced immediately, avascular necrosis (AVN) may develop. Bone remodeling does not take place because a fracture has not occurred. Realignment does not become more difficult with time and pain would subside with time, not become worse.

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

D In joint dislocation, radiographic films show intact yet malpositioned bones. Arthrography or arthroscopy may reveal damage to other structures in the joint capsule. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. Sprains are injuries to the ligaments surrounding a joint. A fracture is a break in the continuity of a bone.

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain? Administer prescribed pain medication only when the client requests it. Avoid administering too much medication because the client is older. Give pain medication to the client after providing care. Administer prescribed analgesics around-the-clock.

D Pain associated with hip fracture is severe and must be carefully managed with around-the-clock dosing of pain medication to minimize energy loss in response to pain. The client may not request the medication even if they are in pain, and it should be offered at the prescribed time. Give pain medication prior to providing any type of care involved in moving the client.

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? Avoid exposure to direct sunlight. Consult a skin specialist. Scrub the area vigorously to remove the crust. Apply lotions and take warm baths or soaks.

D The client should be advised to apply lotions and take warm baths or soaks. This will help in softening the skin and removing debris. The client usually sheds this residue in a few days so the client need not consult a skin specialist. It is not advisable to scrub the area vigorously. The client need not avoid exposure to direct sunlight because the area is not photosensitive.

The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is: Disturbed body image Risk for avascular necrosis of the joint Situational low self-esteem Risk for ineffective therapeutic regimen management

D The client without adequate support and resources is at risk for ineffective therapeutic regimen management. A total knee replacement may be used to treat avascular necrosis. While an orthopedic client is at risk for disturbed body image and situational low self-esteem, there is no evidence that these exist for this client.

Which factor may contribute to compartment syndrome? Disuse syndrome Venous thromboembolus Macular lesion Hemorrhage

D The normal pressure of a compartment can be altered in cases of fracture by the force of the injury itself or by development of edema or hemorrhage at the site of the injury. Venous thromboemboli are another early complication of fracture, but they are not related to compartment syndrome. Macular lesion is caused by the accumulation of blood under the skin, as occurs with trauma such as bone fracture. Disuse syndrome mostly occurs in hip fracture.

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care? "A foul smell from the cast is normal." "Use a knitting needle to scratch itches inside the cast." "Cover the cast with a blanket until the cast dries." "Keep your right leg elevated above heart level."

D The nurse should instruct the client to elevate the leg to promote venous return and prevent edema. The cast shouldn't be covered while drying. Covering the cast will cause heat buildup and prevent air circulation. The client should be instructed not to insert foreign objects into the cast because of the risk of cutting the skin and causing an infection. A foul smell from a cast is never normal and may indicate an infection.

The nurse is caring for a 24-year-old female client with a right tibial fracture treated with a cast 2 hours ago. The client now reports unrelenting pain, rated as 7/10, despite taking oxycodone, and decreased sensation in the right foot. A nursing assessment reveals the right foot is cooler and paler than the left foot, with delayed capillary refill and a weak pulse. Complete the following sentence by choosing from the lists of options. Based on the nursing assessment, the priority action the nurse should take is to notify the orthopedic health care provider immediately and prepare the client for bivalving of the cast

This was a drop down question.

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

A Surgical treatment of compartment syndrome is achieved with a fasciotomy, a surgical incision of the fascia and separation of the muscle to relieve pressure and restore tissue perfusion. Bone graft, joint replacement or amputation may be done for a client who experiences avascular necrosis.

A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied? Short leg cast Long leg cast Walking cast Hip spica cast

A A short leg cast extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed. A walking cast is a short or long leg cast reinforced for strength. A hip spica cast encloses the trunk and a lower extremity.

The nurse is admitting a client who is to undergo an open reduction with internal fixation for a fractured femur. About which comment by the client should the nurse be most concerned? "I was worried I would have an incision and scar." "A joint replacement or bone graft is not necessary." "The surgeon can see the bones when putting them in correct position." "The surgeon is planning to use a metal plate and screws to fix my hip."

A An open reduction involves a surgical dissection for the visualization of the bone ends and fragments. A metal plate and screws are used to correct and stabilize the fracture through internal fixation.

An elite high school football player has been diagnosed and treated for a shoulder dislocation. What should the nurse emphasize during health education to facilitate the player's rejoining the team? The importance of adhering to the prescribed treatment and rehabilitation regimen The importance of monitoring for intracapsular bleeding once he resumes playing The need to take analgesia regardless of the short-term absence of pain The fact that he has a permanently increased risk of future shoulder dislocations

A Clients who have experienced sports-related injuries are often highly motivated to return to their previous level of activity. Adherence to restriction of activities and gradual resumption of activities need to be reinforced. Appropriate analgesia use must be encouraged, but analgesia does not necessarily have to be taken in the absence of pain. If healing is complete, the client does not likely have a greatly increased risk of reinjury. Dislocations rarely cause bleeding after the healing process.

A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for? Left hip arthroplasty Left hip arthroscopy Open reduction and internal fixation of the left hip. Closed reduction of the left hip.

A Clients with arthritis, trauma, hip fracture, or a congenital deformity may have an arthroplasty, or reconstruction of the joint. This procedure uses an artificial joint that restores previously lost function and relieves pain. An arthroscopy is not used to reconstruct a diseased hip. A closed reduction is not an invasive surgical procedure and would not be used to reconstruct the hip. An open reduction and internal fixation is not the treatment for reconstruction of the hip related to a diseased hip.

A client has delayed bone healing in a fractured right humerus. What should the nurse prepare the client for that promotes bone growth? Electrical stimulation Joint fusion Administration of antibiotics Administration of low-dose heparin

A Delayed union may require surgical interventions to promote bone growth and correct the incorrect union. If necessary, prepare the client for use of electrical stimulation measures that promote bone growth, or for a bone graft. Administration of low-dose heparin would be used to prevent pulmonary embolism. Joint fusion may be used in the case of avascular necrosis. Administration of antibiotics would be used for the potential of infection or to treat an actual infection.

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication? Dislocation of the hip Re-fracture of the hip Contracture of the hip Avascular necrosis of the hip

A Manifestations of a dislocated hip prosthesis are increased pain at the surgical site, acute groin pain in the affected leg, shortening of the leg, abnormal external or internal rotation, and limited movement of the fractured leg. The client may report a "popping" sensation in the hip.

A nurse is caring for a client with a cast on the left arm after sustaining a fracture. Which assessment finding is most significant for this client? Fingers on the left hand are swollen and cool Presence of a normal popliteal pulse Cast edges are rough, with skin irritation present Minimal pain in the left arm

A Swollen and cool fingers on the left hand are the most significant assessment findings. They represent altered circulation to the hand caused by the cast. A normal radial, not popliteal, pulse should be present in the left arm; the popliteal pulse is found on the leg. Skin irritation is an abnormal assessment finding but it isn't as significant as altered circulation. Minimal pain in the left arm is expected.

The client scheduled for a Syme amputation is concerned about the ability to eventually stand on the amputated extremity. How should the nurse best respond to the client's concern? "You will eventually be able to withstand full weight-bearing after the amputation." "You likely will not be able to use this extremity but you will receive teaching on use of a wheelchair." "You will have minimal weight-bearing on this extremity but you'll be taught how to use an assistive device." "You will be fitted for a prosthesis which may or may not allow you to walk."

A Syme amputation (modified ankle disarticulation amputation) is performed most frequently for extensive foot trauma and produces a painless, durable extremity end that can withstand full weight-bearing.

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority? Maintaining traction continuously to ensure its effectiveness Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use Supporting the traction weights with a chair or table to prevent accidental slippage Monitoring the client for skin breakdown

A The nurse must maintain skeletal traction continuously to ensure its effectiveness. The nurse should assess skin for breakdown; however, maintaining skeletal traction takes priority. Traction weights must hang freely to be effective; they should never be supported. The nurse should increase, not restrict, the client's fluid and fiber intake (unless contraindicated by a concurrent illness) to prevent constipation associated with complete bed rest.

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse? "Describe the pain and rate it on the pain scale." "Pain medication usually does not help this type of pain." "Your left toes have been amputated." "The pain is really from the nerves in the upper leg."

A The nurse should recognize phantom pain as real and complete a pain assessment as if the limb were attached. The client's pain should be address and treated appropriately. By telling the client that the toes have been amputated or the pain is really from the nerves in the upper leg, the nurse is negating the client's pain. Opioid pain medication can be effective with phantom pain.

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

A fractured bone or other injury can potentially cause dysfunction to the surrounding muscle and injury to the blood vessels and nerves.

Which client(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply. The client with elevated pressure within the muscles The client with hemorrhage in the site of injury The client with a plaster cast applied immediately after injury The client who sustained a clavicle fracture The client using ice to control pain in the extremity

A, B, C Compartment syndrome occurs in cases of fracture when the normal pressure of a compartment is altered by the force of the injury itself, by development of edema, or by hemorrhaging at the site of the injury, which increases the contents of the compartment, or from outside pressure caused by constriction from a dressing or cast. A client with elevated muscle pressure is at risk for compartment syndrome. The application of a plaster cast immediately after the injury places the client at risk for compartment syndrome because the cast will not allow for edema and therefore will compress the tissue. Clavicle fractures are not a risk factor for compartment syndrome because of the location of the fracture. Ice will assist in decreasing edema and may help prevent compartment syndrome.

A client sustains an open fracture of the left arm after an accident. What does emergency management of this fracture involve? Select all that apply. covering the area with a sterile dressing if the fracture is open immobilizing the affected site splinting the injured limb asking the client if they are able to move the arm wrapping the arm in an ace bandage

A, B, C Immediately after injury, if a fracture is suspected, the body part must be immobilized before the client is moved. Adequate splinting is essential. Joints proximal and distal to the fracture also must be immobilized to prevent the movement of fracture fragments. In an upper extremity injury, the arm may be bandaged to the chest, or an injured forearm may be placed in a sling. The neurovascular status distal to the injury should be assessed both before and after splinting to determine the adequacy of peripheral tissue perfusion and nerve function. With an open fracture, the wound is covered with a sterile dressing to prevent contamination of deeper tissues.

A nurse is caring for a client who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.) Encouraging the client to care for the residual limb Allowing the client to express grief Encouraging the client to have family and friends view the residual limb to decrease self-consciousness Encouraging family and friends to refrain from visiting temporarily because this may increase the client's embarrassment Introducing the client to local amputee support groups

A, B, D The nurse helps the client set realistic rehabilitation goals and encourages the client to be an active participant in self-care. The nurse creates an accepting and supportive atmosphere in which the patient and family are encouraged to express and share their feelings and work through the grieving process; support from family and friends promotes the patient's acceptance of the loss. Mental health and support group referrals may be appropriate. Although the nurse supports the client in coming to terms with the appearance and function of the residual limb, and in sharing feelings about the amputation with family and friends, viewing of the residual limb by family and friends is not a priority and may not be helpful for the client's well-being.

A patient has a cast removed after bone healing takes place. What should the nurse instruct the patient to do after removal? (Select all that apply.) Apply an emollient lotion to soften the skin. Use friction to remove dead surface skin by rubbing the area with a towel. Use a razor to shave the dead skin off. Gradually resume activities and exercise. Control swelling with elastic bandages, as directed.

A, D, E The skin needs to be washed gently and lubricated with an emollient lotion. The patient should be instructed to avoid rubbing and scratching the skin, because doing so can cause damage to newly exposed skin. The nurse and physical therapist educate the patient to resume activities gradually within the prescribed therapeutic regimen. Exercises prescribed to help the patient regain joint motion are explained and demonstrated. Because the muscles are weak from disuse, the body part that has been immobilized cannot withstand normal stresses immediately. In addition, the patient should be instructed to control swelling by elevating the formerly immobilized body part, no higher than the heart, until normal muscle tone and use are reestablished.

Which evaluation finding requires follow up by the nurse caring for a client with a total knee replacement? Select all that apply. 650 ml bloody drainage in drain wound Pedal pulses strong and equal bilaterally Client ambulates 10 feet by postoperative day 2 Client reports pain rating of 2. Knee flexion at 30 degrees

A, E A suction drain removes fluid accumulating in the wound. Typical drainage ranges from 200 to 400 ml the first 24 hours after surgery and declines to fewer then 25 ml by 48 hours. Knee mobility is increased with a continuous passive motion (CPM) device. Initial settings of the CPM are usually 10 degrees of extension and 50 degrees of flexion with an ultimate goal of full extension (0 degrees) and 90 degrees of flexion by discharge. A pain rating of 2 is an indicator of effective pain management. Strong and equal pedal pulses are an expected finding. Progressive ambulation begins on the day after surgery; ambulating 10 feet on postoperative day would be expected.

Which term refers to a blunt force injury to soft tissue? Strain Contusion Dislocation Fracture

B A contusion is blunt force injury to soft tissue. A dislocation is a separation of joint surfaces. A strain is a musculotendinous injury. A fracture is a break in the continuity of the bone.

Which cleansing solution is the most effective for use in completing pin site care? Hydrogen peroxide Chlorhexidine Betadine Alcohol

B Chlorhexidine solution is recommended as the most effective cleansing solution; however, water and saline are alternate choices. Hydrogen peroxide and betadine solutions have been used, but they are believed to be cytotoxic to osteoblasts and may actually damage healthy tissue.

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan? Reduce fluid intake. Increase fiber intake. Remove the weights during linen changes. Increase calorie intake.

B Immobility increases the incidence of constipation. Increasing fiber intake will reduce GI complications. The weights in traction should never be removed. Inactivity results in fewer calories being burned. Increasing calories would be counterproductive. Reducing fluids will increase the likelihood of constipation.

Which would be contraindicated as a component of self-care activities for the client with a cast? Do not attempt to scratch the skin under a cast Cover the cast with plastic to insulate it Elevate the casted extremity to heart level frequently Cushioning rough edges of the cast with tape

B The cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. The other activities are consistent with cast care.

The nurse is assisting with the application of a cast. What will the nurse expect to be done first? Applying strips of the cast material evenly. Cleaning the skin surface. Covering the skin with a stockinette. Arranging for an x-ray to check bone alignment.

B When a cast is to be applied, the skin surface of the area to be casted is cleaned and dried. Then the skin is covered with a stockinette, the limb is padded, and rolls or strips of the casting material are applied evenly. Once the cast is applied, an x-ray is done to check bone alignment.

The type of fracture described as having one side of the bone broken and the other side bent would be: transverse. oblique. greenstick. spiral.

C A greenstick fracture is the type of fracture described as having one side of the bone broken and the other side bent. An oblique fracture occurs at an angle across the bone. A spiral fracture is a fracture that twists around the shaft of the bone. A transverse fracture is a fracture that is straight across the bone.

Which is a hallmark sign of compartment syndrome? Motor weakness Weeping skin surfaces Pain Edema

C A hallmark sign of compartment syndrome is pain that occurs or intensifies with passive range of motion.

A nurse is developing a teaching plan for a client who must undergo an above-the-knee amputation of the left leg. After a leg amputation, exercise of the remaining limb: begins at a rehabilitation center. isn't necessary. should begin the day after surgery. should begin immediately postoperatively.

C Exercise of the remaining limb should begin the day after surgery. Exercise is necessary to maintain the muscle tone of the remaining limb. Immediately after surgery, the client usually isn't alert enough to participate and may be in too much pain. Exercise needs to begin before discharge to a rehabilitation center.

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? Atelectasis Hypovolemia Pulmonary embolism Urinary tract infection

C Explanation: Patients having orthopedic surgery are particularly at risk for venous thromboembolism, including deep vein thrombosis and pulmonary embolism.

The nurse is very concerned about the potential debilitating complication of peroneal nerve injury. What symptom does the nurse recognize as a result of that complication? Permanent paresthesias Infection Foot drop Deep vein thrombosis (DVT)

C Injury to the peroneal nerve as a result of pressure is a cause of foot drop (the inability to maintain the foot in a normally flexed position). Consequently, the patient drags the foot when ambulating.

The client with a newly applied cast reports severe unrelenting pain. What is the nurse's best response? Reposition the extremity for comfort and apply heat. Loosen the edges of the cast and elevate the leg. Make the client NPO and notify the health care provider. Administer a dose of morphine sulfate.

C The client is exhibiting symptoms of compartment syndrome. The health care provider needs to be contacted as treatment options include bivalving of the cast or a possible fasciotomy, a surgical procedure. Applying ice rather than heat may provide comfort.

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

C The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint. Amputation refers to the removal of a body part.

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure? Incision and diversion of the muscle fascia Replacement of knee with artificial joint Excision of damaged joint fibrocartilage Replacement of one of the articular surfaces of a joint

C The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint. Total joint arthroscopy is the replacement of a joint with synthetic material.

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching? "I'll get the prescription filled for the narcotic pain reliever." "I'll start with ice for the first couple of hours and then apply heat." "I'll make sure to keep my ankle elevated as much as possible." "I need to stay off my ankle for at least the next 3 to 4 weeks."

C Treatment consists of applying ice or a chemical cold pack to the area to reduce swelling and relieve pain for the first 24 to 48 hours. Elevation of the part and compression with an elastic bandage also may be recommended. After 2 days, when swelling no longer is likely to increase, applying heat reduces pain and relieves local edema by improving circulation. Full use of the injured joint is discouraged temporarily, not necessarily three to four weeks. Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically recommended; narcotic analgesics typically are not prescribed.

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.) 2+ peripheral pulses in the affected distal pulse Capillary refill less than 3 seconds Excruciating pain Loss of motion Decreased sensory function

C, D, E Clinical manifestations include dusky, pale appearance of the exposed extremity; cool skin temperature; delayed capillary refill; paresthesia; and unrelenting pain not relieved by position changes, ice, or analgesia. A hallmark sign is pain that occurs or intensifies with passive range of motion (Johnston-Walker & Hardcastle, 2011). The patient may complain that the cast, brace, or splint is too tight. The primary provider must be notified immediately.

A patient falls while skiing and sustains a supracondylar fracture. What does the nurse know is the most serious complication of a supracondylar fracture of the humerus? Malunion Paresthesia Hemarthrosis Volkmann's ischemic contracture

D The most serious complication of a supracondylar fracture of the humerus is Volkmann contracture (an acute compartment syndrome), which results from antecubital swelling or damage to the brachial artery.

The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the: Trochanteric region. Shaft of the femur. Condylar area. Femoral neck.

D A fracture of the neck of the femur may damage the vascular system and the bone will become ischemic. Therefore, a vascular necrosis is common

A nurse is caring for a client who has sustained ligament and a meniscal injury to the knee. Which action would be most appropriate to allow the client to progress without causing further injury? Administer nonsteroidal anti-inflammatory drugs (NSAIDs) regularly. Apply a cold pack to the affected area every night. Apply heat to the affected area every night. Assist with a gradual introduction of activity.

D A gradual introduction of activity assists the client with a knee injury to ambulate without causing any further injury. Using NSAIDs or applying ice during the first 48 hours helps ease the pain and the inflammation. The application of heat at a later stage improves the blood circulation. However, the regular use of NSAIDs, cold packs, or heat does not help the client progress without causing any further injury.

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

D Hypovolemic shock resulting from hemorrhage is more frequently noted in trauma patients with pelvic fractures and in patients with a displaced or open femoral fracture in which the femoral artery is torn by bone fragments.

A nurse is providing discharge education to a client who is going home with a cast on his leg. What topic should the nurse emphasize in the teaching session? Exercising joints above and below the cast, as prescribed Using crutches efficiently Removing the cast correctly at the end of the treatment period Reporting signs of impaired circulation

D Reporting signs of impaired circulation is critical; signs of impaired circulation must be reported to the physician immediately to prevent permanent damage. For this reason, this education is a priority over exercise and crutch use. The client does not independently remove the cast.

What assessment findings of the leg are consistent with a fracture of the femoral neck? Shortened, abducted, and internally rotated Abducted and externally rotated Adducted and internally rotated Shortened, adducted, and externally rotated

D With fractures of the femoral neck, the leg is shortened, adducted, and externally rotated.

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate? Explain that the sensation being felt is normal and will not burn the client. Administer antianxiety and pain medication. Call for assistance to hold the client in the required position until the cast has dried. Remove the cast immediately, notifying the physician.

A A fiberglass cast will give off heat when applied. The reaction is a normal, temporary sensation. Heat given off during the application phase of the cast does not burn the skin. By explaining these principles to the client, the nurse can alleviate any anxiety associated with the application of the cast. Because this is a known reaction to the application of the fiberglass cast, it is not necessary to remove the cast. Holding the client may cause more harm to the injury. Antianxiety medications are generally not needed when applying a cast.

A client is diagnosed with a first-degree strain of the left ankle related to running 5 miles daily. How would the nurse differentiate the first-degree strain from other strains and sprains? The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices. The client complains of pain when the joint is moved and has mild edema. The client has ecchymosis, edema, and has no function of the left foot and ankle. The client is unable to bear weight on the left ankle and has a large ecchymotic area.

A A first-degree strain involves mild stretching of the muscle or tendon, causing some edema and muscle spasm, but no real loss of function. The second-degree strain is partial tearing of muscle or tendon, leading to inability to bear weight and causing edema, muscle tenderness, muscle spasm, and ecchymosis. The third-degree tear is severe muscle and/or tendon tearing, causing severe pain, muscle spasm ecchymosis, edema, and loss of function. A first-degree sprain involves stretching of the ligament fibers characterized by mild edema, tenderness, and pain if the joint is moved.

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? Assessing the extremity for neurovascular integrity Keeping the client from sliding to the foot of the bed Keeping the ropes over the center of the pulley Ensuring that the weights hang free at all times

A Although all measures are correct, assessing neurovascular integrity takes priority because a decrease in neurovascular integrity could compromise the limb. The pull of the traction must be continuous to keep the client from sliding. Sufficient countertraction must be maintained at all times by keeping the ropes over the center of the pulley. The line of pull is maintained by allowing the weights to hang free.

A nurse is planning the care of a client with osteomyelitis that resulted from a diabetic foot ulcer. The client requires a transmetatarsal amputation. When planning the client's postoperative care, which of the following nursing diagnoses should the nurse most likely include in the plan of care? Disturbed Body Image Risk-Prone Health Behavior Ineffective Thermoregulation Deficient Diversion Activity

A Amputations present a serious threat to any client's body image. None of the other listed diagnoses is specifically associated with amputation.

A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction? Buck's Balanced suspension Thomas splint Crutchfield tongs

A An example of skin traction is Buck's traction. Crutchfield tongs, a Thomas splint, or balanced suspension traction are types of skeletal traction.

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

A An impacted fracture is one in which a bone fragment is driven into another bone fragment. A comminuted fracture is one in which the bone has splintered into several fragments. A compression fracture is one in which bone has been compressed. A greenstick fracture is one in which one side of the bon is broken and the other side is bent.

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

A Depressed skull fractures occur as a result of blunt trauma. A compound fracture is one in which damage also involves the skin or mucous membranes. A comminuted fracture is one in which the bone has splintered into several pieces. An impacted fracture is one in which a bone fragment is driven into another bone fragment.

Which factor inhibits fracture healing? Local malignancy Vitamin D Maximum bone fragment contact Exercise

A Factors that inhibit fracture healing include local malignancy, bone loss, and extensive local trauma. Factors that enhance fracture healing include proper nutrition, vitamin D, exercise, and maximum bone fragment contact.

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? "The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." "The continuous passive motion device can decrease the development of adhesions." "Bleeding is a complication associated with the continuous passive motion device." "Monitoring skin integrity is important while the continuous passive motion device is in place."

A Further staff education is needed when the nurse states that the continuous passive motion device isn't needed because the client receives physical therapy twice per day. The continuous passive motion device should be used in conjunction with physical therapy because the device helps prevent adhesions. Bleeding is a complication associated with the continuous passive motion device; skin integrity should be monitored while the device is in use.

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture? Encourage participation in ADLs Use frequent dependent positioning to prevent edema Administer prescribed enema to prevent constipation Promote intake of omega-3 fatty acids

A General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation with ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care. Omega-3 fatty acids have no implications on the diet of a client with a fracture reduction. Dependent positioning may increase edema because the extremity is below the level of the heart. While some pain medications may contribute to constipation, this intervention would be reserved for a client experiencing constipation and not as a preventative measure.

Which is not a guideline for avoiding hip dislocation after replacement surgery. The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. Never cross the legs when seated. Put a pillow between the legs when sleeping. Keep the knees apart at all times.

A Guidelines for avoiding hip dislocation after replacement surgery specify that the hip should not be flexed to put on clothing such as pants, stockings, socks, or shoes. Clients should keep the knees apart at all times, put a pillow between the legs when sleeping, and never cross the legs when seated.

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

A In a client with a pelvic fracture, the nurse should be aware of the potential for hypovolemic shock resulting from hemorrhage. Cardiogenic shock, in which the heart cannot pump enough blood to meet the body's needs, often arises from severe myocardial infarction. Neurogenic shock is often a consequence of spinal cord injury and resulting loss of sympathetic nervous system function. Septic shock results from body-wide infection.

A client has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing their ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have contributed to this complication? Inadequate immobilization Bleeding at the injury site Venous thromboembolism (VTE) Inadequate vitamin D intake

A Inadequate fracture immobilization can delay or prevent union. A short-term vitamin D deficiency would not likely prevent bone union. VTE is a serious complication but would not be a cause of nonunion. Similarly, bleeding would not likely delay union.

A nurse is caring for a client who is recovering in the hospital following orthopedic surgery. The nurse is performing frequent assessments for signs and symptoms of infection in the knowledge that the client faces a high risk of what infectious complication? Osteomyelitis Septic arthritis Sepsis Cellulitis

A Infection is a risk after any surgery, but it is of particular concern for the postoperative orthopedic client because of the risk of osteomyelitis. Orthopedic clients do not have an exaggerated risk of cellulitis, sepsis, or septic arthritis when compared to other surgical clients.

A classic indicator of edema and alveolar hemorrhage associated with Fat Embolism Syndrome is: Hyperventilation. Tachypnea. Tachycardia. Crackles and wheezes.

A Occlusion of the small vessels in the alveoli leads to a PaO2 of less than 80 mm Hg with an early respiratory alkalosis. The patient experiences hyperventilation in an attempt to get oxygen into the lungs

A group of students are reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast? Better molding to the client Quicker drying More breathable Longer-lasting

A Plaster casts require a longer time for drying, but mold better to the client, and are initially used until the swelling subsides. Fiberglass casts dry more quickly, are lighter in weight, longer-lasting, and breathable.

The nurse caring for a client, who has been treated for a hip fracture, instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client? Do not flex the hip more than 90 degrees. Do not flex the hip more than 120 degrees. Do not flex the hip more than 30 degrees. Do not flex the hip more than 60 degrees.

A Proper alignment and supported abduction are encouraged for hip repairs. Flexion of the hip more than 90 degrees can cause damage to the a repaired hip fracture.

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

A Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely, with the client in good alignment in the center of the bed.

A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse? "A splint is applied when more swelling is expected at the site of injury." "You would have to stay here much longer because it takes a cast longer to dry." "Not all fractures require a cast." "It is best if an orthopedic doctor applies the cast."

A Splints are noncircumferential and will not compromise circulation when swelling is expected. A splint is applied to support and immobilize the injured joint. A fracture will swell as part of the inflammation process. The client would not have to stay longer if a fiberglass cast is applied. Fiberglass cast dry in approximately 30 minutes. An orthopedic doctor is not needed to apply the cast. Many nurses and technicians are trained in proper application of a cast. Some fractures may not be treated with a cast but it would not be appropriate to answer with this response because it does not reflect the actual reason for a splint being applied.

A client with a fractured femur is placed in skeletal traction. Which intervention will increase client independence when moving in bed? Apply a trapeze to the bed frame. Instruct to use the elbows to reposition. Remove the weights prior to repositioning. Remind to use the heel of the unaffected foot to reposition.

A To encourage movement, an assistive device called a trapeze can be suspended overhead within easy reach of the client. The trapeze helps the client move about in bed and move on and off the bedpan. The client's elbows frequently become sore, and nerve injury may occur if the client repositions by pushing on the elbows. Clients frequently push on the heel of the unaffected leg when they raise themselves. This digging of the heel into the mattress may injure the tissues. It is important to instruct clients not to use their heels or elbows to push themselves up in bed. The weights should not be removed to reposition the client or for any other reason.

A client is about to have a cast applied to the left arm. The nurse will tell the client to expect which of the following? A Sensation of warmth or heat with application Increased in pain in left arm A Sensation of weakness The arm being moved to various positions

A When a cast is applied, the client needs to be aware that he or she may feel a sensation of warmth or heat due to the material being mixed with water. The client should not feel an increase in pain during the application. The arm will be held in place to ensure proper alignment during the application. The client should not feel weakness in the extremity. This is more commonly experiences after a cast is removed.

A client returns to the nursing unit following an open reduction with internal fixation of the right hip. Which nursing interventions would be appropriate for the prophylactic treatment of deep vein thrombosis? Select all that apply. Administering enoxaparin Increasing fluid intake Maintaining antiembolic stockings Increasing fiber intake Encouraging coughing exercises

A, B, C Increasing fluid intake decreases stasis by lessening hemoconcentration. Antiembolic stockings and administering enoxaparin are standards of care associated with decreasing deep vein thrombosis. Encouraging coughing exercises helps to reduce respiratory complications. Increased fiber intake increases bulk in stool, but does not prevent deep vein thrombosis.

A client with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? Select all that apply. Assess the fingers for color and temperature. Assess for a pressure sore Determine the exact site of the pain. Administer a prescribed analgesic to promote comfort and allay anxiety. Cut the cast with a cast saw

A, B, C Neurovascular assessment includes the assessment of peripheral circulation, motion, and sensation of the affected extremity, assessing the fingers or toes of the affected extremity, and comparing them with those of the opposite extremity. When assessing peripheral circulation, the nurse must check peripheral pulses as well as capillary refill response (within 3 seconds), edema, and the color and temperature of the skin. The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the client to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer.

The nurse is caring for a client who has been diagnosed with a rotator cuff tear. What option(s) for treating this condition does the nurse identify? Select all that apply. arthroscopic surgery corticosteroid injections nonsteroidal anti-inflammatory drugs (NSAIDs) activity modification and joint rest traction

A, B, C, D NSAIDs, modifying activities and resting the joint, arthroscopic surgery, corticosteroid injections, and open acromioplasty with tendon repair are all treatment options for a rotator cuff tear. Traction is not an option to treat a rotator cuff tear.

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) "Use a raised toilet seat and high-seated chair." "Place pillows between your legs when you lay on your side." "You may cross your legs at the ankles only." "Avoid bending forward when sitting in a chair." "It is okay to briefly flex the hip to put on your clothes."

A, B, D The client following post hip replacement should not cross the legs, even at the ankle. He or she should avoid bending forward when sitting in a chair, avoid flexing the hip when dressing, and use a raised toilet seat. A pillow should be placed between the legs when side-lying.

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment? Malunion Nonunion Delayed union Subluxation

B Nonunion results from failure of the ends of a fractured bone to unite in normal alignment. Delayed union occurs when there is prolonged healing for union of the fracture. In malunion, there is flawed union of fractured bone. Subluxation is a partial dislocation of the articulating surfaces.

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

B A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment.

Which nursing diagnosis takes highest priority for a client with a compound fracture? Impaired physical mobility related to trauma Infection related to effects of trauma Imbalanced nutrition: Less than body requirements related to immobility Activity intolerance related to weight-bearing limitations

B A compound fracture involves an opening in the skin at the fracture site. Because the skin is the body's first line of defense against infection, any skin opening places the client at risk for infection. Imbalanced nutrition: Less than body requirements is rarely associated with fractures. Although Impaired physical mobility and Activity intolerance may be associated with any fracture, these nursing diagnoses don't take precedence because they aren't as life-threatening as infection.

Which device is designed specifically to initially support and immobilize a body part in a desired position until swelling subsides? Brace Splint Continuous passive motion (CPM) device Trapeze

B A splint may be applied to a fractured extremity initially until swelling subsides. A brace is an externally applied device to support a body part, control movement, and prevent injury. A CPM device is an instrument that moves a body part to promote healing and circulation. A trapeze is an overhead device to promote client mobility in bed.

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

B A sprain is an injury to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A contusion is a soft tissue injury resulting from a blow or blunt trauma. A fracture is a break in the continuity of a bone.

The nurse is caring for a client who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis? Keep the hip flexed by placing pillows under the client's knee. Protect the affected leg from internal rotation. Have the client reposition himself independently. Keep the affected leg in a position of adduction.

B Abduction of the hip helps to prevent dislocation of a new hip joint. Rotation and adduction should be avoided. While the hip may be flexed slightly, it shouldn't exceed 90 degrees and maintenance of flexion isn't necessary. The client may not be capable of safe independent repositioning at this early stage of recovery.

The nurse is helping to set up Buck's traction on an orthopedic client. How often should the nurse assess circulation to the affected leg? Within 30 minutes, then every 4 hours Within 30 minutes, then every 1 to 2 hours Within 30 minutes, then every shift Within 30 minutes, then every 8 hours

B After skin traction is applied, the nurse assesses circulation of the foot or hand within 15 to 30 minutes and then every 1 to 2 hours.

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last? At least 1 week Between 24 and 48 hours About 72 hours Less than 24 hours

B After the acute inflammatory stage (e.g., 24 to 48 hours after injury), intermittent heat application (for 15 to 30 minutes, four times a day) relieves muscle spasm and promotes vasodilation, absorption, and repair.

A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client? Insertion of an external fixator Cutting a cast window Cutting of a bivalve cast Removal of the cast

B After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing. A bivalve cast is when the cast is cut in two if the leg swells or if the client is being weaned from a cast, when a sharp x-ray is needed, or as a splint for immobilizing painful joints when a client has arthritis. The cast should not be removed due to the instability of a fracture. The client's condition does not indicate an external fixator is required.

A client was climbing a ladder, slipped on a rung, and fell on the right side of the chest. X-ray studies reveal three rib fractures, and the client reports pain with inspiration. What is the anticipated treatment for this client? Mechanical ventilation Coughing and deep breathing with pillow splinting Chest strapping Thoracentesis

B Because these fractures cause pain with respiratory effort, the client tends to decrease respiratory excursions and refrains from coughing. As a result, tracheobronchial secretions are not mobilized, aeration of the lung is diminished, and a predisposition to atelectasis and pneumonia results. To help the client cough and take deep breaths and use an incentive spirometer, the nurse may splint the chest with his or her hands, or may educate the client on using a pillow to temporarily splint the affected site.

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? Remove the traction at least every 8 hours. Teach the client how to prevent problems caused by immobility. Assess the client's level of consciousness. Apply the traction straps snugly.

B By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removing skeletal traction is the physician's responsibility — not the nurse's.

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

B Chronic osteomyelitis may occur after persistent infection in the late postoperative period. Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period.

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? 72 hours 24 hours 1 week 2 to 3 weeks

B Following hip arthroplasty (total hip replacement), patients begin ambulation with the assistance of a walker or crutches within a day after surgery.

Which may occur if a client experiences compartment syndrome in an upper extremity? Subluxation Volkmann's contracture Callus Whiplash injury

B If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a claw-like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation.

The nurse teaching the client with a cast about home care includes which instruction? Cover the cast with plastic or rubber Dry a wet fiberglass cast thoroughly to avoid skin problems Keep the cast below heart level Fix a broken cast by applying tape

B Instruct the client to keep the cast dry, to dry a wet fiberglass cast thoroughly to avoid skin problems, and not to cover it with plastic or rubber. A cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. A casted extremity should be elevated frequently to heart level to prevent swelling. A broken cast should be reported to the physician and the client should not attempt to fix it.

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention? Promote elimination with a regular bedpan. Keep the cast clean and dry. Keep the legs in abduction. Position the client on the affected side.

B Keeping the cast clean and dry around the perineal opening is a priority. A spica cast has a built-in abduction bar. The client should be positioned on the unaffected side every 2 hours and prone twice a day. A fracture bedpan is easier to use for the client with a spica cast.

Which nursing intervention is essential in caring for a client with compartment syndrome? Starting an I.V. line in the affected extremity in anticipation of venogram studies Removing all external sources of pressure, such as clothing and jewelry Keeping the affected extremity below the level of the heart Wrapping the affected extremity with a compression dressing to help decrease the swelling

B Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity.

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? "The occupational therapist is showing me how to use a sock puller to help me get dressed." "I don't know if I'll be able to get off that low toilet seat at home by myself." "I need to remember not to cross my legs. It's such a habit." "I'll need to keep several pillows between my legs at night."

B The client requires additional teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Teaching the client to avoid crossing the legs also reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees.

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain? Sore and aching Sharp and piercing Similar to "muscle cramps" A dull, deep, boring ache

B The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the client to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale. Most pain can be relieved by elevating the involved part, applying ice or cold packs, and administering analgesic agents as prescribed. Pain associated with the underlying condition (e.g., fracture, which is sharp and piercing) is frequently controlled by immobilization. Pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can frequently be controlled by elevation and, if prescribed, intermittent application of ice or cold packs. Ice bags (one third to one half full) or cold application devices are placed on each side of the cast, if prescribed, making sure not to indent or wet the cast. Unrelieved or disproportionate pain may indicate complications. Pain associated with compartment syndrome is relentless and is not controlled by modalities such as elevation, application of ice or cold, and usual dosages of analgesic agents. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer. This may also occur from too-tight elastic wraps used to hold splints in place.

A client had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated? The leg length is the same as the right leg. The left leg is internally rotated. There are diminished peripheral pulses on the affected extremity. The client has discomfort when moving in bed.

B The nurse must monitor the client for signs and symptoms of dislocation of the prosthesis, which include abnormal external or internal rotation of the affected extremity. The length of the leg with a dislocated prosthesis may be shorter. The client's discomfort will not indicate a dislocation. Diminished peripheral pulse of the affected extremity would be a indication of circulation issues.

A client experienced an open fracture to the left femur during a horse-riding accident. For which complication is this client at highest risk? Malunion Infection Depression Complex regional pain syndrome

B This client is at the highest risk for infection because of the open fracture that was obtained while horseback riding. Infection that enters the body and affects the bone can lead to osteomyelitis. The treatment may involve long-term antibiotics and may even result in death. The client is still at risk for malunion, but this risk is slight because the bone can be visualized (either through the wound or surgical intervention) and returned to anatomical position. The other options are possible consequences of this type of injury but do not represent the most serious complication.

Which intervention would the nurse implement with the client in a plaster cast? Select all that apply. Notify health care provider, if client reports warmth of the cast. Trim, reshape, and smooth edges of cast. Position casted extremity firmly on a hard surface while drying. Protect wet cast by covering with sheet. Handle wet cast with palms of hands.

B, E An exothermic reaction occurs during the application of the cast, whereby the client will experience a sensation of increasing warmth that may be uncomfortable. The cast should not be covered to allow air to circulate to promote drying of the cast. A plaster cast requires 24 to 72 hours to dry completely. Plaster casts are susceptible to dents as they are drying. The nurse should handle the cast with the palms of the hands and avoid resting the drying cast on a hard surface. The nurse may need to trim, reshape, and smooth the edges of the cast to minimize skin irritation.

The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding? Extension of the fingers of the right hand Nodules on the knuckles of the third and fourth finger Claw-like deformity of the right hand without ability to extend fingers Dislocation of the fingers

C A Volkmann's contracture is a claw like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. The client is unable to extend the fingers and complains of unrelenting pain, particularly if attempting to stretch the hand. Nodule on the knuckles and dislocation are not indicative of Volkmann's contracture.

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

C A compound fracture is one in which the skin or mucous membrane wound extends to the fractured bone. A complete fracture involves a break across the entire cross section of the bone and is frequently displaced. An incomplete fracture involves a break through only part of the cross section of the bone. A simple fracture is one that does not cause a break in the skin.

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? Total joint arthroplasty Joint arthroplasty Open reduction Arthrodesis

C An open reduction is the correction and alignment of the fracture after surgical dissection and exposure of the fracture. Arthrodesis is immobilizing fusion of a joint. A joint arthroplasty or replacement is the replacement of joint surfaces with metal or synthetic materials. A total joint arthroplasty is the replacement of both the articular surfaces within a joint with metal or synthetic materials.

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

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

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for: Shortening and deformity. Swelling and discoloration. Capillary refill. Crepitus.

C Assessment for neurovascular impairment includes checking for weak pulses or delayed capillary refill (normal is <2 seconds).

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect? Hypovolemic shock Infection Avascular necrosis Pulmonary embolism

C Avascular necrosis refers to the death of the bone from insufficient blood supply, typically manifested by complaints of increased pain and decreased function. Fever or redness, purulent drainage, and swelling of the site would suggest infection. Respiratory distress would suggest a pulmonary embolism. Changes in vital signs, level of consciousness, and signs and symptoms of fluid loss would suggest hypovolemic shock.

Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia? Fat embolism syndrome (FES) Complex regional pain syndrome (CRPS) Disseminated intravascular coagulation (DIC) Avascular necrosis (AVN)

C DIC is a systemic disorder that results in widespread hemorrhage and microthrombosis with ischemia. AVN of the bone occurs when the bone loses its blood supply and dies. CRPS is a painful sympathetic nervous system problem. FES occurs when the fat globules released when the bone is fractured occludes the small blood vessels that supply the lungs, brain, kidneys, and other organs.

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

C Explanation: In joint dislocation, radiographic films show intact yet malpositioned bones. Arthrography or arthroscopy may reveal damage to other structures in the joint capsule. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. Sprains are injuries to the ligaments surrounding a joint. A fracture is a break in the continuity of a bone.

A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period? Unexplainable burning pain (causalgia) Chronic osteomyelitis Hematoma Neuroma

C Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period. Sleeplessness, nausea, and vomiting may occur but are adverse reactions, not complications. Chronic osteomyelitis and causalgia are potential complications that are likely to arise in the late postoperative period. A neuroma occurs when the cut ends of the nerves become entangled in the healing scar. This would occur later in the postoperative course.

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures? Paresthesia and ischemia Thrombophlebitis and infection Hemorrhage and shock Paralytic ileus and a lacerated urethra

C Hemorrhage and shock are two of the most serious consequences that may occur in a pelvic fracture.