CH 41, NUR 1172: Prep U Module 1, Chapter 40 Musculoskeletal Care Modalities

A group of students is 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? -More breathable -Longer lasting -Quicker drying -Better molding to the client

-Better molding to the client

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.) -Decreased sensory function -Capillary refill less than 3 seconds -Loss of motion -2+ peripheral pulses in the affected distal pulse -Excruciating pain

-Decreased sensory function -Loss of motion -Excruciating pain

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 -Contracture of the hip -Re-fracture of the hip -Avascular necrosis of the hip

-Dislocation of the hip

Which intervention should the nurse implement with the client who has undergone a hip replacement? -Instruct the client to avoid internal rotation of the leg. -Adduct the legs by placing a pillow between the legs. -Place the client in high Fowler's position for meals. -Have the client bend forward to rise from the chair.

-Instruct the client to avoid internal rotation of the leg.

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

-Keep the cast clean and dry.

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

-Pulmonary embolism

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

-Sharp and piercing

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

-The left leg is internally rotated.

Common cause of death in patients diagnosed with fat emboli syndrome.

ARDS

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation? -Internal rotation -Adduction -Abduction -Flexion

Abduction

Which of the following statements describes paresthesia?

Abnormal Sensations

This is an inconsistent initial pain relief measure for the patient with a cast.

Application of a New Cast

Indicator of neurovascular compromise.

Capillary Refill >3 Seconds

Shaft of the long bone.

Diaphysis

Colles' fracture occurs in this area.

Distal Radius

Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure? -Arthrodesis -Fasciotomy -Arthroplasty -Osteotomy

Fasciotomy

Early complication of fracture healing.

Fat Embolism Syndrome

Lifestyle risk factors for osteoporosis includes this.

Lack of Exposure to Sunshine

Factor that inhibits fracture healing.

Local Malignancy

Excision of damage joint fibrocartilage.

Meniscectomy

Failure of fragments of a fractured bone to heal together.

Nonunion

A fracture is termed pathologic when the fracture:

Occurs through an area of diseased bone.

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identify this as? -Internal fixation -Open reduction -Buck's traction -Skeletal traction

Open reduction

The nurse is taking the health history of a newly admitted client. Which of the following conditions would place the client at risk for impaired immune function?

Previous Organ Transplantation

Serum albumin is an indicator of which type of deficiency?

Protein

Spinal cord injury pt has no awareness of the needed void.

Reflex (Neurogenic) Incontinence

Lateral curving of the spine.

Scoliosis

Lab study indicates the rate of bone turnover.

Serum Osteocalcin

Pt with CTS experience pain in the hands. What to help assuage the pain in the pt?

Shake the hands

Designed to support and immobilize a body part in a desired position.

Splint

When assessing the patient with osteoporosis, nurse finds that the patient takes antacids. Which information should the nurse give to the patient?

Take antacids containing calcium

Which sign may be helpful in identifying carpal tunnel syndrome?

Tinel's

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? "It is best if an orthopedic doctor applies the cast." "A splint is applied when more swelling is expected at the site of injury." "Not all fractures require a cast." "You would have to stay here much longer because it takes a cast longer to dry."

"A splint is applied when more swelling is expected at the site of injury."

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

"A splint is applied when more swelling is expected at the site of injury." Explanation: 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 experience swelling as part of the inflammation process. The patient 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.

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

"CPM increases range of motion of the joint." Explanation: CPM increases circulation and range of motion of the knee joint.

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide? a) "Intermittently cross and uncross your legs several times each day." b) "Avoid weight bearing until the hip is completely healed." c) "Limit hip flexion to 90 degrees." d) "Perform rotation exercises each day."

"Limit hip flexion to 90 degrees." Explanation: The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. The hip should not bend more than 90 degrees. Ambulation begins the day following surgery, and weight bearing ambulation may not be restricted, depending on the type of prosthesis.

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) "Metal pins will go through my skin to the bone." b) "I will wear a boot with weights attached." c) "A belt will go around my pelvis and weights will be attached." d) "The traction can be removed once a day so I can shower."

"Metal pins will go through my skin to the bone." Explanation: 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.

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." -"Monitoring skin integrity is important while the continuous passive motion device is in place." -"Bleeding is a complication associated with the continuous passive motion device."

"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device."

A patient diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse? a) "The method will allow for the fastest healing time and the greatest mobility." b) "This will allow for the strength in the arm to remain consistent." c) "The joint above the fracture and below the fracture must be immobilized." d) "When a spica cast is ordered, the arm must be immobilized."

"The joint above the fracture and below the fracture must be immobilized." Explanation: Generally, the joints proximal and distal to the fracture are immobilized to promote healing. The purpose is not for the strength to remain consistent, most patients will lose strength. A spica cast would not be ordered for an ulnar fracture. Although immobilizing the joints above and below fractures may aide in healing time, it does not allow for increased mobility.

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? -Heart rate of 94 beats/minute -Client complains of pain in the affected rib area when taking a deep breath -Blood pressure of 140/90 mm Hg -Crackles in the lung bases

-Crackles in the lung bases

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? -Cutting of a bivalve cast -Cutting a cast window -Insertion of an external fixator -Removal of the cast

-Cutting a cast window

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? -Assess the client's level of consciousness. -Teach the client how to prevent problems caused by immobility. -Remove the traction at least every 8 hours. -Apply the traction straps snugly.

-Teach the client how to prevent problems caused by immobility.

The client displays manifestations of compartment syndrome. The nurse expects the client to be scheduled for: a) A total hip replacement b) A total knee replacement c) An open reduction d) A fasciotomy

A fasciotomy Explanation: A treatment option for compartment is fasciotomy.

The post-amputation client is seen by the home health nurse. One client outcome included preventing exposure to infection. Which finding would indicate to the nurse that this outcome was met?

Absence of Fever

Which nursing action would help prevent deep vein thrombosis in a client who has had an orthopedic surgery? -Instruct about exercise, as prescribed -Instruct about using client-controlled analgesia, if prescribed -Apply anti embolism stockings -Apply cold packs

Apply ant-embolism stockings

The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery? a) Anticoagulation therapy b) Antidysrhythmia therapy c) Antianginal therapy d) Antineoplastic therapy

Anticoagulation therapy Explanation: Anticoagulation therapy and early ambulation are very important for clients who have knee or hip replacement to prevent thrombus formation. The other therapy is not indicated solely for the knee or hip arthroplasty.

Which of the following would be an inconsistent initial pain relief measure for the patient with a cast? a) Application of a new cast b) Application of cold packs c) Elevation of the involved part d) Administration of analgesics

Application of a new cast Explanation: Most pain can be relieved by elevating the casted part of the body, and by applying cold packs as prescribed and administering analgesics. Application of a new cast is usually not necessary.

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? -Scrub the area vigorously to remove the crust. -Apply lotions and take warm baths or soaks. -Avoid exposure to direct sunlight. -Consult a skin specialist.

Apply lotions and take warm baths or soaks.

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? a) Avoid exposure to direct sunlight. b) Apply lotions and take warm baths or soaks. c) Scrub the area vigorously to remove the crust. d) Consult a skin specialist.

Apply lotions and take warm baths or soaks. Explanation: 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.

Surgical fusion of a joint.

Arthrodesis

Identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist.

Arthrography

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 for a pressure sore -Administer a prescribed analgesic to promote comfort and allay anxiety. -Assess the fingers for color and temperature. -Cut the cast with a cast saw -Determine the exact site of the pain.

Assess for a pressure sore Assess the fingers for color and temperature. Determine the exact site of the pain.

A client has a fiberglass cast on the right arm. Which action should the nurse include in the care plan?

Assessing movement and sensation in the fingers of the right hand

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

Assessing the extremity for neuromuscular integrity Explanation: 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 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

Assessing the extremity for neurovascular integrity

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? a) Better molding to the client b) Longer-lasting c) Quicker drying d) More breathable

Better molding to the client Explanation: 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.

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.

Pt learn to consciously contract excretory sphincters and control voiding cues.

Biofeedback

Which of the following clinical manifestations would the nurse expect to find in a client who has Paget's disease?

Bowing of the legs

Medication directly inhibits osteoclasts thereby reducing bone loss and increasing BMD.

Calcitonin (Miacalcin)

A client who is undergoing skeletal traction complains of pressure on bony areas. Which action would be most appropriate to provide comfort for the client? a) Applying warm compresses. b) Changing the client's position within prescribed limits. c) Assisting with range-of-motion and isometric exercises. d) Administering prescribed analgesics.

Changing the client's position within prescribed limits. Explanation: Changing the position of a client within prescribed limits helps relieve pressure on bony areas and promotes comfort. Analgesics help to relive pain but may not help relieve pressure on bony areas. Warm compresses aid blood circulation. The client should not exercise while on traction unless prescribed to regain strength in the affected limb.

Most effective cleansing solution to complete pin site care.

Chlorhexidine

Complication the nurse closely monitored in late postop period of patient who has its arm amputated surgically.

Chronic Osteomyelitis and Causalgia

A client was playing softball and dislocated four of his fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as? a) Closed reduction b) Open reduction with internal fixation c) Open reduction d) External fixation

Closed reduction Explanation: In a closed reduction, the bone is restored to its normal position by external manipulation. A bandage, cast, or traction then immobilizes the area. In an open reduction, the bone is surgically exposed in the operating room and realigned. If internal fixation is needed to stabilize a reduced fracture, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pin.

NV problem caused by pressure within a muscle area that increase to such an extent that microcirculation diminishes.

Compartment Syndrome

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

Cover the cast with plastic to insulate it

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

Cover the cast with plastic to insulate it Explanation: 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.

A client sustained a stable fracture of the cervical spine and is having skeletal traction applied. What type of traction does the nurse educate the client about? a) Crutchfield tongs b) Thomas splint c) Kirschner wires d) Steinmann pins

Crutchfield tongs Explanation: Crutchfield tongs are cranial tongs that are used to maintain alignment for a cervical fracture. Kirschner wires and Steinmann pins are used for the skeletal traction to attach to. A Thomas splint is used to suspend a leg in traction.

A 34-year-old client fractured his distal left radius while weight lifting. He returns to the emergency department, reporting discomfort at the cast site, with pain specifically in his upper forearm. What would you expect the physician to do? a) Remove the cast. b) Apply a fiberglass cast. c) Initiate physical therapy. d) Cut a cast window.

Cut a cast window. Explanation: 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

Alters urinary elimination patterns in older adults.

Decrease Muscle Tone

A group of students are reviewing the structure and function of bones. The students demonstrate understanding of the information when they state that cortical bone is found primarily in which of the following?

Diaphyses

Pulselessness late sign of compartment syndrome and of this.

Diminished Arterial Perfusion

A client who suffers an injury in a local high school hockey game presents with left shoulder pain. The client cannot move the left arm, and the left shoulder is lower than the right shoulder. The nurse recognizes the client most likely has a:

Dislocated Shoulder

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 of the following complications? a) Dislocation of the hip b) Avascular necrosis of the hip c) Re-fracture of the hip d) Contracture of the hip

Dislocation of the hip Explanation: 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 client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? -Elevate the affected extremity and use cold applications. -Breathe deeply and cough every 2 hours until ambulation is possible. -Do ROM exercises as indicated -Apply anti-embolism stockings as indicated

Elevate the affected extremity and use cold applications.

A rehabilitation nurse is assisting a patient to cope with a disability. Which of the following would the nurse suggest?

Emphasize areas of strengths.

Which of the following definitions describes the hip spica cast? a) Encircles the trunk b) 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. c) A short or long leg cast reinforced for strength d) Encloses the trunk and a lower extremity

Encloses the trunk and a lower extremity Explanation: 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 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? -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. -Explain that the sensation being felt is normal and will not burn the client.

Explain that the sensation being felt is normal and will not burn the client.

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

Explain that the sensation being felt is normal and will not cause burns to the patient. Explanation: A fiberglass cast when applied will give off heat. The reaction is a normal, temporary sensation. Heat given off during the application phase of the cast does not cause burns to the skin. By explaining these principles to the patient, 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 patient may cause more harm to the injury. Antianxiety medications are generally not needed when applying a cast.

Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure? a) Osteotomy b) Fasciotomy c) Arthrodesis d) Arthroplasty

Fasciotomy Explanation: A fasciotomy is a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure. An osteotomy is a surgical cutting of bone. An arthroplasty is a surgical repair of a joint. Arthrodesis is a surgical fusion of a joint.

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan? -Fingers on the left hand are swollen and cool -Presence of a normal popliteal pulse -Minimal pain in the left arm -Cast edges are rough, with skin irritation present

Fingers on the left hand are swollen and cool

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

Fingers on the left hand are swollen and cool Explanation: 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.

A client has just undergone a leg amputation. The nurse would closely monitor the client for which of the following during the immediate postoperative period? a) Neuroma b) Chronic osteomyelitis c) Unexplainable burning pain (causalgia) d) Hematoma

Hematoma Explanation: 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.

Which type of cast encloses the trunk and a lower extremity? -Short-leg -Hip spica -Body cast -Long-leg

Hip spica

Which type of cast encloses the trunk and a lower extremity? a) Body cast b) Hip spica c) Short-leg d) Long-leg

Hip spica Explanation: A hip spica cast encloses the trunk and a lower extremity. A body cast encloses the trunk. A long-leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. A short-leg cast extends from below the knee to the base of the toes.

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 Farenheit, 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 of the following complications? a) Osteomyelitis b) Hypovolemic shock c) Atelectasis d) Urinary retention

Hypovolemic shock Explanation: 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.

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

I was worried I would have an incision and scar."

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

Increase fiber intake. Explanation: 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.

The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, "How can I stay like this for weeks? I can't even move!" Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis? a) Ineffective Coping related to prolonged immobility b) Deficient Diversional Activity related to prolonged hospitalization c) Activity Intolerance related to impaired mobility d) Impaired Physical Mobility related to traction

Ineffective Coping related to prolonged immobility Explanation: The client is displaying clinical manifestations of anxiety and ineffective coping.

Which intervention should the nurse implement with the client who has undergone a hip replacement? a) Have the client bend forward to rise from the chair. b) Place the client in high Fowler's position for meals. c) Instruct the client to avoid internal rotation of the leg. d) Adduct the legs by placing a pillow between the legs.

Instruct the client to avoid internal rotation of the leg. Explanation: The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. A pillow is used to keep the legs in abduction. The hip should not bend more than 90 degrees when seated. The head of bed should be kept at 60 degrees or less.

A client spends most of his time in a wheelchair. The nurse would be especially alert for the development of pressure ulcers in which area?

Ischial tuberosity

Type of therapeutic exercise performed by the patient where the muscle contracts and relax.

Isometric

Which of the following is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? a) It prevents infection and controls edema and bleeding. b) It provides active range of motion. c) It promotes healing by increasing circulation and movement of the knee joint. d) It promotes healing by immobilizing the knee joint.

It promotes healing by increasing circulation and movement of the knee joint. Explanation: A CPM device applied after knee surgery promotes healing by increasing circulation and movement of the knee joint.

The nurse is caring for a client with a spica cast. A priority nursing intervention is to: a) Keep the legs in abduction. b) Keep the cast clean and dry. c) Position the client on the affected side. d) Promote elimination with a regular bedpan.

Keep the cast clean and dry. Explanation: 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.

Mature compact bone structures that form concentric rings of bone matrix.

Lamellae

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 arthroscopy -Closed reduction of the left hip. -Open reduction and internal fixation of the left hip. -Left hip arthroplasty

Left hip arthroplasty

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? a) Left hip arthroscopy b) Open reduction and internal fixation of the left hip. c) Closed reduction of the left hip. d) Left hip arthroplasty

Left hip arthroplasty Explanation: 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.

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide?

Limit hip flexion to 90 degrees

Which nursing intervention is appropriate for minimizing muscle spasms in the client with a hip fracture?

Maintain Buck's traction.

The nurse is caring for a client who has had a fracture reduction using a cast. Which of the following would be most important for the nurse to assess? a) Sleep status b) Renal function c) Neurovascular status d) Cardiac status

Neurovascular status Explanation: When caring for a client with a fracture, the nurse should carefully assess neurovascular status, checking for possible complications. Assessment of cardiac and renal status would be priorities if the client experienced multiple fractures or had an open reduction. The client's sleep status would be a low priority.

The nurse teaches the patient which of the following interventions in order to avoid hip dislocation after replacement surgery? a) Keep the knees together at all times b) Never cross the affected leg when seated c) Bend forward only when seated in a chair d) Avoid placing a pillow between the legs when sleeping

Never cross the affected leg when seated Explanation: Crossing the affected leg may result in dislocation of the hip joint after total hip replacement. The patient should be taught to keep the knees apart at all times. The patient should be taught to put a pillow between the legs when sleeping. The patient should be taught to avoid bending forward when seated in a chair.

The nurse is caring for a client with an external fixator that requires pin care twice a day. The nurse observes that there is a new purulent drainage around one of the pins. What intervention should the nurse anticipate doing? a) Apply ointment to the pin site. b) Scrubbing the drainage from around the pin site c) Applying iodine-based solution d) Obtaining a culture

Obtaining a culture Explanation: A culture should be obtained if purulent drainage is present. Drainage should be gently removed, not scrubbed. Iodine-based products interfere with tissue healing and are not recommended for cleaning pin sites. Ointment should not be applied to the pin site unless specifically ordered.

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

Open reduction

Which of the following orthopedic surgeries is done to correct and align a fracture after surgical dissection and exposure of the fracture? a) Open reduction b) Total joint arthroplasty c) Arthrodesis d) Joint arthroplasty

Open reduction Explanation: 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.

A client's fracture was reduced by surgically exposing the bone and realigning it. The nurse identifies this as which of the following? a) Buck's traction b) Internal fixation c) Open reduction d) Skeletal traction

Open reduction Explanation: In an open reduction, the bone is surgically exposed and realigned. Buck's traction is a type of skin traction that provides pulling on the structures. Skeletal traction is applied directly to the bone using a wire, pin, or cranial tongs. Internal fixation involves the use of metal screws, plates, rods, nails or pins to stabilize a reduced fracture.

A variety of complications can occur after a leg amputation. All of the following are possibilities in the immediate postoperative period, except? a) Hemorrhage b) Osteomyelitis c) Infection d) Hematoma

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

Hallmark sign of compartment syndrome.

Pain

Which therapeutic exercise is done by the nurse without assistance from the patient?

Passive

A 12-year-old client fractured her right leg several weeks ago while skiing and is returning to the orthopedist to have her cast removed. What would you expect the physician to prescribe as further treatment? a) Apply cold compresses to leg for swelling. b) No options are correct. c) Discontinue use of crutches. d) Physical therapy

Physical therapy Explanation: For some time, the limb will need support. An elastic bandage may be wrapped on a leg, the client may use a cane, and an arm may be kept in a sling until progressive active exercise and physical therapy help the client regain normal strength and motion.

The client presents with nausea and vomiting, sluggish bowel sounds, and abdominal distention. The nurse interprets these findings as suggestive of: a) Physiologic cast syndrome b) Impaired physical mobility c) Psychological cast syndrome d) Disuse syndrome

Physiologic cast syndrome Explanation: Physiological cast syndrome is characterized by impaired gastrointestinal function, such as nausea and vomiting, sluggish bowel sounds, and abdominal distention.

Which of the following is a characteristic of fracture pain?

Piercing

A rehabilitation nurse is preparing a presentation for clients and caregivers about issues that clients with disabilities may face. Which of the following would be most appropriate for the nurse to include in the presentation?

Priority setting is helpful in dealing with the impact of the disability.

Which action by the nurse would be inappropriate for the client following casting? -Handle the cast with the palms of hands. -Protect the cast by covering with a sheet. -Petal and smooth the edges of the cast. -Circulate room air with a portable fan.

Protect the cast by covering with a sheet.

Which action by the nurse would be inappropriate for the client following casting? a) Petal and smooth the edges of the cast. b) Protect the cast by covering with a sheet. c) Circulate room air with a portable fan. d) Handle the cast with the palms of hands.

Protect the cast by covering with a sheet. Explanation: The nurse performs actions to facilitate drying of the cast. The cast should be exposed to air. Portable fans can be used to dry the cast. Pressure on the cast should be avoided.

Which of the following terms refers to disease of a nerve root?

Radiculopathy

Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women?

Raloxifene

Phase of bone healing after fracture does callus formation occur.

Reparative

A nurse is giving instructions to a client who's going home with a cast on his leg. Which teaching point is most critical? a) Using crutches properly b) Reporting signs of impaired circulation c) Exercising joints above and below the cast, as ordered d) Avoiding walking on a leg cast without the physician's permission

Reporting signs of impaired circulation Explanation: Although all of these points are important, reporting signs of impaired circulation is the most critical. Signs of impaired circulation must be reported to the physician immediately to prevent permanent damage. The other options reflect more long-term concerns. The client should learn to use his crutches properly to avoid nerve damage. The client may exercise above and below the cast, as the physician orders. The client should be told not to walk on the cast without the physician's permission.

A client has Paget's disease. An appropriate nursing diagnosis for this client is:

Risk for Falls

Which of the following is an inappropriate nursing diagnosis for the client following casting? a) Risk for impaired skin integrity b) Risk for deficient knowledge: procedure c) Risk for impaired tissue perfusion d) Risk for disuse syndrome

Risk for deficient knowledge: procedure Explanation: The client needs adequate information before experiencing the procedure. Information about its purpose, the actual steps of the procedure, and the client's role during and after the procedure is essential. Appropriate nursing diagnoses following the procedure would include risk for disuse syndrome, risk for impaired skin integrity, and risk for impaired tissue perfusion.

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

Risk for ineffective therapeutic regimen management

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

Risk for ineffective therapeutic regimen management Explanation: 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.

A client is about to have a cast applied to his left arm. The nurse would alert the client to which of the following as the cast is applied? a) Increased in pain in left arm b) Sensation of warmth or heat with application c) Arm being moved to various positions d) Sensation of weakness

Sensation of warmth or heat with application Explanation: When a cast is applied, the client needs to be aware that he 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.

Skin or mucous membranes extends to the fractured bone.

Simple Fracture

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

Skeletal traction is interrupted to turn an deposition that client.

Inaccurate principle of traction.

Skeletal traction is interrupted to turn and reposition the patient.

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

Skeletal traction is interrupted to turn and reposition the patient. Explanation: Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely with the patient in good alignment in the center of the bed.

Conservative treatment of a compressed nerve root is first line treatment. What conservative treatment is used to increase the distance between vertebrae and decrease severe muscle spasm? a) Sleeping on a hard mattress with a bed board b) Cool, moist compresses c) Skeletal traction d) Skin traction

Skin traction Explanation: Skin traction, which can be applied in the home, is used to decrease severe muscle spasm as well as increase the distance between adjacent vertebrae, keep the vertebrae correctly aligned, and, in many instances, relieve pain. Treatment relieves symptoms for an extended period.

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

Splint

Which device is designed specifically to support and immobilize a body part in a desired position? a) Splint b) Traction c) Brace d) Sling

Splint Explanation: 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 sling is used to support an arm and traction is the use of a pulling force on a body part

A 19-year-old client presents at the emergency department with a compound fracture of the right femur. Skeletal traction is applied to align the bones. What type of traction would you expect to be used? a) Russell traction b) Thomas splint c) Buck's traction d) Steinmann traction

Steinmann traction Explanation: Skeletal traction is applied directly to a bone by using a wire (Kirschner), pin (Steinmann), or cranial tongs (Crutchfield). General or local anesthesia may be used when inserting these devices.

During assessment, a patient reports that she sometimes "wets herself" when sneezing. The nurse documents this as which of the following?

Stress incontinence

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

Swing-through

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?

Teach the client how to prevent problems caused by immobility.

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? a) Apply the traction straps snugly. b) Assess the client's level of consciousness. c) Remove the traction at least every 8 hours. d) Teach the client how to prevent problems caused by immobility.

Teach the client how to prevent problems caused by immobility. Explanation: 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.

Which of the following statements is accurate regarding care of a plaster cast? a) The cast will dry in about 12 hours. b) A dry plaster cast is dull and gray. c) The cast must be covered with a blanket to keep it moist during the first 24 hours. d) The cast can be dented while it is damp.

The cast can be dented while it is damp. Explanation: The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding.

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

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes,

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fracture tibia. What should the nurse inform the client prior to the cast being removed? a) The skin may be covered with a yellowish crust that will shed in a few days. b) The leg will look as it did prior to the cast being applied. c) The leg will look moist and will have small bumps that will go away in a few days. d) The leg strength is enforced by the wearing of the cast.

The skin may be covered with a yellowish crust that will shed in a few days. Explanation: Once the cast is off, the skin appears mottled and may be covered with a yellowish crust composed of accumulated body oil and dead skin. The client usually sheds this residue in a few days. The leg will not look as it did prior to the cast but will regain the same shape and status as the other leg. There should be no bumps underneath the cast. The leg may be weak and stiff for some time after the cast is removed, not stronger.

Which statement describes external fixation? -The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. -The bone is surgically exposed and realigned. -The bone is restored to its normal position by external manipulation. -The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? -Osteotomy -Hemiarthroplasty -Arthrodesis -Total arthroplasty

Total arthroplasty

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? a) Arthrodesis b) Total arthroplasty c) Hemiarthroplasty d) Osteotomy

Total arthroplasty Explanation: A total arthroplasty is a replacement of both articular surfaces within one joint. An arthrodesis is a fusion of a joint for stabilization and pain relief and is usually done on a wrist or knee. A hemiarthroplastyis the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. An osteotomy is the cutting and removal of a wedge of bone to change the bone's alignment, thereby improving function and relieving pain.

A patient is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm? a) Proper use of a sling b) Use of isometric exercises c) Abduction and adduction of the shoulder d) Repositioning the arm in the cast

Use of isometric exercises Explanation: Isometric exercises allow for use of the muscle without moving the bone. Doing isometric exercises every hour while the patient is awake will help prevent disuse syndrome. Proper use of a sling does not prevent disuse syndrome. The patient should not attempt to reposition the arm in the cast. Abduction and adduction of the shoulder will help the shoulder joint but does not require the use of muscles in the lower arm.

A male patient with a musculoskeletal injury is instructed to alter his diet. The objective of this diet alteration is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which of the following food items should the nurse encourage the patient to include in the diet?

Vitamin D-Fortified Milk

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions?

Walk or perform weight-bearing exercises outdoors.

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

Weights hanging and touching the floor

All of the following are guidelines for avoiding hip dislocation after replacement surgery. Select the answer that is not. a) Never cross the legs when seated. b) Put a pillow between the legs when sleeping. c) Keep the knees apart at all times. d) You may flex at the hip to put on clothing such as pants, stockings, socks, or shoes.

You may flex at the hip to put on clothing such as pants, stockings, socks, or shoes. Explanation: "Do not flex at the hip to put on clothing such as pants, stockings, socks, or shoes" is the correct guideline. Keep the knees apart at all times. Put a pillow between the legs when sleeping. Never cross the legs when seated.

A hip spica cast: -is a short or long leg cast reinforced for strength. -encloses the trunk and a lower extremity. -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.

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

osteomyelitis

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

• "Use a raised toilet seat and high-seated chair." • "Place pillows between your legs when you lay on your side." • "Avoid bending forward when sitting in a chair." Explanation: 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 evaluation finding requires follow up by the nurse caring for a client with a total knee replacement? Select all that apply. a) Pedal pulses strong and equal bilaterally b) 650 ml bloody drainage in drain wound c) Client reports pain rating of 2. d) Client ambulates 10 feet by postoperative day 2 e) Knee flexion at 30 degrees

• 650 ml bloody drainage in drain wound • Knee flexion at 30 degrees Explanation: 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.

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply. a) Immobilization of the left leg will be maintained. b) The bones of the left leg will be aligned. c) Less pain medication will be required. d) Muscle spasms will be relieved. e) Surgery will not be required.

• Immobilization of the left leg will be maintained. • The bones of the left leg will be aligned. • Muscle spasms will be relieved. Explanation: Traction is used to relieve muscle spasm, align bones, and maintain immobilization when used properly. It will not replace surgery to correct the fracture. The client will still require pain medication prior to surgical correction.

A patient with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care? Select all that apply. a) Prepare for cast removal. b) Assess neurovascular status every 8 hours. c) Provide support to the injured extremity. d) Apply ice to extremity. e) Elevate the arm above the heart.

• Prepare for cast removal. • Provide support to the injured extremity. Explanation: The nurse should anticipate immediate removal of the cast and provide support to the injured extremity. Neurovascular status should be assessed more frequently than every 8 hours. If the patient is not showing improvement in the neurovascular status, then a fasciotomy may be needed. Waiting 8 hours to assess neurovascular status may cause permanent damage to the extremity. To promote arterial blood flow, the arm should be elevated to the heart level, not above. Ice should not be used as it could further decrease blood flow to the extremity.

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

Maintaining traction continuously to ensure its effectiveness Explanation: 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 nurse is given instructions to a client who's going home with a leg cast. Which teaching point is most critical? -Avoiding walking on a leg cast without the health care provider's permission -Exercising joints above and below the cast, as ordered -Using crutches properly -Reporting signs of impaired circulation

Reporting signs of impaired circulation

A nurse is describing the concept of habilitation to a group of families who have members in need of these services. Which of the following statements would the nurse include in this description?

"Habilitation focuses on the person's abilities."

A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first? -"My toes are stiff" -"My cast is still wet -"My pain is 3" -My toes are pink"

"My toes are stiff"

A group of students are reviewing information about osteoporosis in preparation for a class discussion. The students demonstrate a need for additional review when they state which of the following as a risk factor?

Hypothyroidism

A 12-year-old client fractured her right leg while skiing and is undergoing an open reduction of the femur fracture. She returns to the orthopedic unit where you practice nursing with a cast in place. What is the rationale for frequently assessing her pedal pulses? a) Making sure surgery was successful b) Typical postoperative nursing management c) Ensuring there wasn't nerve damage during surgery d) Maintaining adequate circulation

Maintaining adequate circulation Explanation: Circulation, sensation, and mobility of exposed fingers or toes must be assessed every 1 to 2 hours to ensure neurovascular status is not compromised.

The nurse assesses a client after total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. why is the priority action of the nurse? -Apply Bucks traction. -Notify the health care provider. -Bend the knee and rotate the knee internally. -Externally rotate the extremity.

Notify the health care provider.

Which nursing assessment finding indicates the client with traction has not met expected outcomes? a) Capillary refill < 3 seconds b) Repositions self with trapeze c) Right calf warm and swollen d) Peripheral pulses +2 bilaterally

Right calf warm and swollen Explanation: Deep vein thrombosis is a potential complication of the client immobilized by traction. Clinical manifestations of deep vein thrombosis include calf tenderness, warmth, redness, and swelling of the affected extremity.

A client is about to have a cast applied to the left arm. What will nurse alert the client to as the cast is applied? -Sensation of weakness -Increase in pain in the left arm -Arm being moved to various positions -Sensations of warmth or heat with application

Sensations of warmth or heat with application

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

Weights hanging and touching the floor Explanation: 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 is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

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

A client is seen in the emergency department for an injury acquired from falling off a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurses why a splint is applied and not a cast. What is the best explanation by the nurse? -"You will be able to wear the splint longer than you would a cast." -"The arm does not require the same immobilization that a leg fracture would." -"We will need to monitor the status of the laceration to be sure it does not get infected." -" The splint is less expensive than the cast."

"We will need to monitor the status of the laceration to be sure it does not get infected."

A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse? a) "The splint is less expensive than the cast." b) "You will be able to wear the splint longer than you would a cast." c) "We will need to monitor the status of the laceration to be sure it does not get infected." d) "The arm does not require the same immobilization that a leg fracture would."

"We will need to monitor the status of the laceration to be sure it does not get infected." Explanation: A splint would be used when there is special skin treatment or observation that is required. The arm fracture would require the same form of immobilization that a leg fracture does. The length of time the splint can be worn is equal to that of a cast to immobilize the fracture. The cost of the splint and cast would be similar.

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

24 hours

The nurse is reviewing the client's admission assessment and notes that crepitus of the right knee joint was documented. The nurse recognizes that crepitus is:

A grating sound when a joint is put through range of motion.

A client is scheduled to have an x-ray examination of his shoulder in which the synovial fluid will be aspirated and sent to the laboratory for analysis. This will be followed by administration of a contrast medium and x-rays. The nurse understands that the client will be undergoing which of the following?

Arthrogram

A client has a Fiberglas cast on the right arm. Which action should the nurse include in the care plan? a) Assessing movement and sensation in the fingers of the right hand b) Keeping the casted arm warm by covering it with a light blanket c) Avoiding handling the cast for 24 hours or until it is dry d) Evaluating pedal and posterior tibial pulses every 2 hours

Assessing movement and sensation in the fingers of the right hand Explanation: The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting circulation. To reduce the risk of skin breakdown, the nurse should leave a casted arm uncovered, which allows air to circulate through the cast pores to the skin below. Unlike a plaster cast, a Fiberglas cast dries quickly and can be handled without damage soon after application. The nurse should assess the brachial and radial pulses distal to the cast — not the pedal and posterior tibial pulses, which are found in the legs.

Which action would be most important postoperatively for a client who has had a knee or hip replacement? -Encouraging expressions of anxiety. -Assisting in early ambulation. -Providing crutches to the client. -Using a continuous passive motion (CPM) machine.

Assisting in early ambulation.

Which action would be most important postoperatively for a client who has had a knee or hip replacement? a) Using a continuous passive motion (CPM) machine. b) Encouraging expressions of anxiety. c) Providing crutches to the client. d) Assisting in early ambulation.

Assisting in early ambulation. Explanation: An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement. A CPM machine or crutches may be provided when prescribed. It is important to encourage clients to express their feelings of anxiety or depression. This is more crucial for clients who undergo an amputation rather than for clients who undergo a replacement surgery.

Instructions for the patient with low back pain include that when lifting the patient should:

Avoid Overreaching

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? a) Buck's b) Balanced suspension c) Thomas splint d) Crutchfield tongs

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

Infection is blood bone the manifestations include which of the following symptoms?

Chills

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.) -Control swelling with elastic bandages, as directed. -Use friction to remove dead surface skin by rubbing the area with a towel. -Apply an emollient lotion to soften the skin. -Use a razor to shave the dead skin off. -Gradually resume activities and exercise.

Control swelling with elastic bandages, as directed. Apply an emollient lotion to soften the skin. Gradually resume activities and exercise.

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? a) Blood pressure of 140/90 mm Hg b) Crackles in the lung bases c) Client complains of pain in the affected rib area when taking a deep breath d) Heart rate of 94 beats/minute

Crackles in the lung bases Explanation: Crackles in the lung bases can be an indicator that the client has developed pneumonia from shallow respirations. The blood pressure is high but may be due to pain. It is expected that the client will have pain in the rib area when taking deep breaths. A heart rate of 94 beats/minuteis within normal range

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? a) Cutting of a bivalve cast b) Removal of the cast c) Cutting a cast window d) Insertion of an external fixator

Cutting a cast window Explanation: 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 patient with a tibia fracture was placed in an external fixator 24 hours ago. The nurse is completing pin care and notices redness at the pin site and a small amount of serous drainage. What action by the nurse is appropriate? a) Assess patient's hemoglobin and hematocrit. b) Prepare for surgical removal of the fixator. c) Document the findings. d) Notify the physician.

Document the findings. Explanation: Serous drainage and redness at the pin site is an expected finding for 24-48 hours postinsertion. The nurse should document the findings and continue to monitor the site. The physician does not need to be notified unless other signs and symptoms are present. The fixator does not need to be removed at this time. The greatest concern is for infection; assessing the hemoglobin and hematocrit are not relevant to assessing for infection.

Mr. Williams returned to the nursing unit following orthopedic surgery and is complaining of pain. Which of the following interventions will help relieve pain? a) Instruct client to deep breathe and cough every 2 hours until he can ambulate. b) Elevate the affected extremity and use cold applications. c) Encourage client to do ROM exercises as indicated. d) Apply antiembolism stockings as indicated.

Elevate the affected extremity and use cold applications. Explanation: Elevating the affected extremity and using cold applications reduce swelling. This intervention helps with maintenance of effective respiratory rate and depth. This intervention helps maintain full ROM of unaffected joints. They help prevent deep vein thrombosis (DVT).

A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client? a) Urging her to keep the affected limb in an elevated position. b) Advising the client to avoid red meat. c) Exploring factors related to the client's home environment. d) Educating the client about the effects of menopause.

Exploring factors related to the client's home environment. Explanation: Exploring factors related to the older adult client's home environment and determining a plan for continued rehabilitation before discharge is most important. The client should be encouraged to eat foods rich in protein, calcium, and vitamin D. Since the healing is almost complete, the client need not always keep the affected limb elevated unless prescribed to do so. Since the client is in her late 60s, she is most likely to have already undergone menopause. Therefore, educating her about the effects of menopause is not as important.

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? -Deep vein thrombosis (DVT) -Permanent paresthesias -Footdrop -Infection

Footdrop

Dupuytren's contracture causes flexion of this areas.

Fourth and Fifth Fingers

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

Increase fiber intake.

Which intervention should the nurse implement with the client who has undergone a hip replacement?

Instruct the client to avoid internal rotation of the leg.

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? -It provides active range of motion -It promotes healing by immobilizing the knee joint -It prevents infection and controls edema and bleeding -It promotes healing by increasing circulation and movement of the knee joint.

It promotes healing by increasing circulation and movement of the knee joint

A client has undergone an external fixation. Which actions would be the priority for this client? a) Planning the client's diet. b) Monitoring the client's urine output. c) Monitoring the client's blood pressure. d) Maintaining pin care.

Maintaining pin care. Correct Explanation: Pin care is a priority for a client with external fixation, because pin sites are entry points for infection. The nurse should also monitor redness, drainage, and tenderness at the site. Planning the client's diet and monitoring the client's urine output and blood pressure, although necessary, are not as important as maintaining pin care.

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

Maintaining traction continuously to ensure its effectiveness

A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize? -Right shoulder slopes downward and droops inward -Client complains of tingling and numbness in the right shoulder. -Client complains of pain in the unaffected shoulder. -Right shoulder is elevated above the left.

Right shoulder slopes downward and droops inward

A client is brought to the emergency department by a softball team member whostates the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize? a) Client complains of pain in the unaffected shoulder. b) Right shoulder is elevated above the left. c) Right shoulder slopes downward and droops inward. d) Client complains of tingling and numbness in the right shoulder.

Right shoulder slopes downward and droops inward. Explanation: The client with a fractured clavicle has restricted motion, and the affected shoulder appears to slope downward and droop inward. The client will have pain, not typically tingling and numbness in the right shoulder. Pain is not felt in the unaffected shoulder.

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

Rotator Cuff Tears

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? -Long leg cast -Short leg cast -Hip spica cast -Walking cast

Short leg cast

Which of the following principles apply to the patient in traction? a) Knots in the ropes should touch the pulley b) Skeletal traction is never interrupted c) Weights are removed routinely d) Weights should rest on the bed

Skeletal traction is never interrupted Explanation: Skeletal traction is applied directly to the bone and is never interrupted. In order to be effective, the weights must hang freely and not rest on the bed or floor. Knots in the rope or the footplate must not touch the pulley or the foot of the bed. Traction must be continuous to be effective in reducing and immobilizing fractures.

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

excision of damaged joint fibrocartilage. Explanation: 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 nurse is conducting an admission history of a client admitted with a fracture. The nurse recognizes that which of the client's medications placed the client at risk for fractures?

prednisone (Deltasone)

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 increases range of motion of the joint." - "CPM strengthens the muscles of the leg." - "CPM prevents injury by limiting flexion of the knee." -"CPM delivers analgesic agents directly into the joint."

"CPM increases range of motion of the joint."

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

"Metal pins will go through my skin to the bone."

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

"Place pillows between your legs when you lay on your side." "Avoid bending forward when sitting in a chair." "Use a raised toilet seat and high-seated chair."

The nurse is preparing the client for computed tomography. Which information should be given by the nurse?

"You must remain very still during the procedure."

Which of the following nursing actions would help prevent deep vein thrombosis in a patient who has had an orthopedic surgery? a) Instructing about exercise, as prescribed b) Instructing about using patient-controlled analgesia, if prescribed c) Applying cold packs d) Applying antiembolism stockings

Applying antiembolism stockings Explanation: Applying antiembolism stockings helps prevent deep vein thrombosis (DVT) in a patient who is immobilized due to orthopedic surgery. Regular administration of analgesics controls and prevents escalation of pain while ROM exercises help in maintaining muscle strength and tone and prevent contractions. On the other hand, cold packs are applied to help reduce swelling and this does not prevent deep vein thrombosis.

A patient with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which of the following is the priority action by the nurse? a) Reposition the patient for comfort. b) Teach relaxation techniques. c) Assess for previous opioid drug use. d) Assess for complications.

Assess for complications. Explanation: Unrelieved pain can be an indicator of a complication, such as, compartment syndrome. Previous opioid drug use should not influence a complete and thorough assessment. Repositioning the patient for comfort may be appropriate once all indications of a complication are ruled out. It is appropriate to teach relaxation techniques to help ease the pain, but assessing for a complication remains the highest priority.

After undergoing surgery the previous day for a total knee replacement, a client states that he doesn't feel ready to ambulate yet. What should the nurse do? a) Tell the client that she'll contact the physician and report his noncompliance. b) Document the client's refusal to ambulate. c) Discuss the complications that the client's may experience if he doesn't cooperate with the care plan. d) Do nothing because the client has the ultimate right to determine his degree of participation.

Discuss the complications that the client's may experience if he doesn't cooperate with the care plan. Explanation: The nurse should discuss the care plan and its rationale with the client. Calling the physician to report the client's noncompliance won't alter the client's degree of participation and shouldn't be used to force the client to comply. Doing nothing isn't acceptable. Although the client does have the right to make choices, it's the nurse's responsibility to provide education to help the client make informed decisions. Although the nurse should ultimately document the client's refusal, she should first discuss the care plan with the client.

A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. the nurse identifies this as which type of cast? -Gauntlet Cast -Spica Cast -Short Arm Cast -Body Cast

Gauntlet Cast

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? -Osteomyelitis -Hypovolemic Shock -Atelectasis -Urinary Retention

Hypovolemic Shock

The nurse is preparing a client for a hip replacement with the use of porous-coated cementless joint components. What does the nurse know is the benefit of this type of component? a) It prevents the client from developing infection related to the application of cement in the joint spaces. b) The client will not reject the prosthesis because there is no cement on the prosthetics. c) The component is less expensive because there is no cement used. d) It allows the bone to grow into the prosthesis and securely fix the joint replacement in place.

It allows the bone to grow into the prosthesis and securely fix the joint replacement in place. Explanation: Porous-coated cementless joint components are used to allow the bone to grow into the prosthesis and thus securely fix the joint replacement in place. The prosthesis is not less expensive and cost is not a factor in reconstruction. The client may still have a local or systemic reaction to the prostheses even if it does not have cement.

What stage of pressure ulcer development does the ulcer extend into the subcutaneous tissue?

Stage III

Type of incontinence is associated with weakened perineal muscles that permit the leakage of urine when intra-abdominal pressure is increased.

Stress Incontinence

Which of the following statements describes external fixation? a) The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. b) The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. c) The bone is surgically exposed and realigned. d) The bone is restored to its normal position by external manipulation.

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. Explanation: In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. In internal fixation, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. In closed reduction, the bone is restored to its normal position by external manipulation. In open reduction, the bone is surgically exposed and realigned.