Ch. 43 hip fractures

Two days after application of a cast to treat a fractured femur, the patient tells the orthopedic heath care provider that he is experiencing severe, deep, and constant pain in his leg. The nurse suspects a diagnosis of:

Compartment syndrome.

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:

should begin the day after surgery.

Which type of fracture produces several bone fragments?

Comminuted

Which factor may contribute to compartment syndrome?

Hemorrhage

A classic indicator of edema and alveolar hemorrhage associated with FES is:

Hyperventilation.

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

Prevent internal rotation of the affected leg.

Which intervention should the nurse implement, when caring for the client who complains of phantom limb pain two months after amputation?

Reassure the client that phantom pain is common.

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 with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?

Elevating the stump for the first 24 hours

Which nursing diagnosis takes highest priority for a client with a compound fracture?

Risk for infection related to effects of trauma

The nurse advises a 36-year-old patient who suffered a severe wrist sprain subsequent to a fall that she can begin progressive passive and active exercises in:

1 to 3 weeks.

A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of his activity limitations when he states that he will need to wear the brace for which length of time?

6 to 8 weeks

Two days after surgery to amputate his left lower leg, a client states that he has pain in the missing extremity. Which action by the nurse is most appropriate?

Administer medication, as ordered, for the reported discomfort.

Which nursing intervention is appropriate for a patient with a closed reduction extremity fracture?

Encouraging participation in ADLs

Which of the following is a factor that inhibits fracture healing?

Local malignancy

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

"I don't know if I'll be able to get off that low toilet seat at home by myself."

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 analgesics around-the-clock.

When is it advisable for the nurse to apply heat to a sprain or a contusion?

After 2 days

When reviewing the history of a female client with a ganglion cyst, which factor would the nurse identify as most likely contributing to the client's current condition?

Age below 50 years

After an arm fracture, the nurse practitioner advises the patient that pendulum exercises are begun:

As soon as tolerated, after a reasonable period of immobilization.

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. The nurse would suspect which of the following?

Avascular necrosis

There are a variety of problems that can become complications after a fracture. Which of the following is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head?

Avascular necrosis

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?

Clawlike deformity of the right hand without ability to extend fingers

A client reports to the emergency department after experiencing pain in the left arm. The client reports that he extended his arms in an attempt to prevent a fall. Which fracture type does the nurse anticipate?

Colles' fracture

Which assessment findings would the nurse expect to find in the postoperative client experiencing fat embolism syndrome?

Column B

A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states that he cannot feel or move his fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures?

Compartment syndrome

A client comes to the emergency department complaining of localized pain and swelling of his 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?

Contusion

Which of the following is a term used to describe a soft tissue injury produced by a blunt force?

Contusion

General nursing measures employed when caring for the client with fracture include all of the following, except?

Cranial nerve assessment

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear?

Difficulty lying on affected side

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?

Fat emboli

When evaluating for hypovolemic shock, the nurse should be aware of which of the following clinical manifestations?

Hypotension

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

A patient suffered an open fracture to the left femur during a horse-riding accident. For which of the following complications is this patient at highest risk?

Infection

The nurse is caring for a patient who sustained an open fracture of the right femur in an automobile accident. What does the nurse understand is the most serious complication of an open fracture?

Infection

A 39-year-old softball player has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would you expect the physician to perform?

Joint manipulation and immobilization

A 19-year-old patient presents to the emergency room with an injury to her left ankle that occurred during a high school basketball game. She complains of limited motion and pain on walking, which increased over the last 2 hours. The nurse knows that her diagnosis is most likely which of the following?

Second-degree sprain

A client sustains an injury to the ligaments surrounding a joint. The nurse identifies this as which of the following?

Sprain

Which of the following terms refers to an injury to ligaments and other soft tissues of a joint?

Sprain

A 45-year-old softball player arrives at the emergency department following his injury while sliding into a base during a game. After his examination and radiographs, the physician diagnoses muscle strain and prescribes appropriate treatment. What does the physician mean with the term "strain"?

Stretched or pulled beyond its capacity

Which of the following may occur if a client experiences compartment syndrome in an upper extremity?

Volkmann's contracture

When joint manipulation is unsuccessful for a client, he is taken to surgery for surgical repair of his hip injury. He is brought to the ICU where you practice nursing for postoperative recovery. After surgery, the nurse implements measures to prevent complications. Select all of the following which are complications that the nurse seeks to prevent.

Wound infection Pneumonia Skin breakdown

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include:

inability to perform active movement and pain with passive movement.

Which assessment findings would cause the nurse to suspect compartment syndrome after casting of the leg?

Complaints of numbness and tingling in toes of affected leg

Which of the following disorders results in widespread hemorrhage and microthrombosis with ischemia?

Disseminated intravascular coagulation (DIC)

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?

Fat embolism

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing:

Fat embolism syndrome

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

Maintain Buck's traction.

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment?

Nonunion

Which of the following terms refers to failure of fragments of a fractured bone to heal together?

Nonunion

A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall?

Pathologic fracture

A patient with a traumatic amputation of the right lower leg is refusing to look at the leg. Which of the following actions by the nurse is most appropriate?

Provide feedback on the patient's strengths and available resources.

In a patient with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which of the following complications do the assessments help the nurse to monitor in the patient?

Compartment syndrome

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?

Between 24 and 48 hours

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention?

Compound

The nurses 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.

A client presents to the emergency department gently holding the left arm, which is slightly swollen and painful to the touch. Based on these findings, the nurse:

Elevates the arm and applies an ice pack

An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as?

Subluxation