ch 62 Musculoskeletal Trauma (fractures, traction, amputations)

The nurse is caring for a client who had surgery to repair a fractured left-sided hip using a posterior approach. In implementing hip precautions, which action should the nurse teach the client to avoid? 1. Crossing legs at the ankle 2. Using an elevated toilet seat 3. Placing a pillow between the legs 4. Keeping the legs abducted from the midline

1. Crossing legs at the ankle NCLEX

The nurse is caring for a client who was just admitted to the hospital with a diagnosis of a fractured right hip sustained from a fall 5 hours earlier. The nurse develops a plan of care for the client and includes interventions related to monitoring for signs of fat embolism. Which findings should be listed in the care plan as a sign/symptom of fat embolism? 1. Dyspnea and chest pain 2. Fever and chills 3. External rotation of the right leg 4. Pallor, paresthesia, and pulselessness of the right lower leg

1. Dyspnea and chest pain NCLEX

The nurse is caring for a client who has just had a plaster leg cast applied. The nurse should plan to prevent the development of compartment syndrome by performing which action? 1. Elevate the limb slightly. 2. Elevate the limb above heart level. 3. Keep the leg horizontal, and cover the limb with bath blankets. 4. Place the leg in a slightly dependent position, and apply ice to the affected leg.

1. Elevate the limb slightly. NCLEX

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

1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated. (cool setting on hair dryer, don't stick anything into cast, numbness and tingling = bad) NCLEX

The nurse is creating a plan of care for a client scheduled for a left total hip arthroplasty. Which interventions should the nurse include in the plan to prevent complications of the surgery? Select all that apply. 1. Keep the leg slightly abducted. 2. Teach leg exercises to the client. 3. Use aseptic technique for wound care. 4. Prevent hip flexion beyond 90 degrees. 5. Keep the client's knees flexed whenever the client is in bed. 6. Massage the legs daily to increase circulation and venous return.

1. Keep the leg slightly abducted. 2. Teach leg exercises to the client. 3. Use aseptic technique for wound care. 4. Prevent hip flexion beyond 90 degrees. NCLEX

priority nursing interventions for fat embolism (4)

1. contact healthcare provider (doctor) 2. administer oxygen 3. IV fluids (prevent hypovolemic shock) 4. monitor vital signs and respiratory status

6 P's of compartment syndrome

1. pain out of proportion to the injury, unrelieved by drugs 2. pressure 3. paresthesia (numbness, tingling) 4. pallor, coolness 5. paralysis 6. pulselessness

The nurse teaches a client who is going to have a plaster cast applied about the procedure. Which statement by the client indicates a need for further teaching? 1. "The cast will give off heat as it dries." 2. "I can bear weight on the cast in one-half hour." 3. "The cast edges may be trimmed with a cast knife." 4. "A stockinette will be placed over the leg area to be casted."

2. "I can bear weight on the cast in one-half hour." (plaster takes 24-72 hrs to dry) NCLEX

comminuted fracture

a fracture with more than 2 fragments, the smaller fragments appear to be floating

pathologic fracture

a spontaneous fracture at the site of a diseased bone

If needed, which surgical treatment will the nurse first prepare the patient for in the presence of compartment syndrome? a. Fasciotomy b. Amputation c. Internal fixation d. Release of tendons

a. Fasciotomy MS workbook

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

a. altered mental status ATI MS

The nurse instructs the patient with an above-the-knee amputation that the residual limb should not be routinely elevated because this position promotes: a. hip flexion contractures b. skin irritation and breakdown c. clot formation at the incision site d. increased risk of wound dehiscence

a. hip flexion contractures MS

greenstick fracture

an incomplete fracture with one side splintered and the other side bent

what distinguishes a fat embolism from a pulmonary embolism?

fat embolism = petechiae (pinpoint-sized subdermal hemorrhages) on the neck and chest

open fracture concerns

open fracture = bone exposed to air through a break in the skin -soft tissue injury -infection

oblique fracture

the line of the fracture extends across and down the bone

transverse fracture

the line of the fracture extends across the bone shaft

spiral fracture

the line of the fracture extends in a spiral direction along the bone shaft

4 interventions for a fracture

-reduction: restores the bone to proper alignment -fixation -traction: pulling force applied in 2 directions to reduce and immobilize a fracture -cast (NCLEX)

Buck's traction

-skin traction used to alleviate muscle spasms and immobilize a lower limb by maintaining a straight pull on the limb with the use of weights -boot appliance -hip fractures

closed reduction

-when a pulling force (traction) is applied manually to realign the displaced fracture bone fragments -nonsurgical

open reduction

-when a surgical incision is made and the bone is manually aligned and kept in place with plates and screws -aka internal fixation

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

3. Impaired tissue perfusion NCLEX

A male client arrives in the hospital emergency department and tells the nurse that he twisted his ankle while jogging. The client is seen by the health care provider (HCP) and is diagnosed with a sprained ankle. The nurse provides instructions to the client regarding home care for the injury. Which statement, if made by the client, would indicate an understanding of appropriate care measures for the next 24 hours? 1. "I should place hot packs on my ankle." 2. "I should wrap my ankle with blankets." 3. "I should elevate my foot above the level of the heart." 4. "I should try to ambulate at least 10 minutes out of every hour."

3. "I should elevate my foot above the level of the heart." NCLEX

The nurse is caring for a client who had developed compartment syndrome from a severely fractured arm. The client asks the nurse how this can happen. The nurse should respond by incorporating which piece of information? 1. A bone fragment has injured the nerve supply in the area. 2. An injured artery causes impaired arterial perfusion through the compartment. 3. Bleeding and swelling cause increased pressure in an area that cannot expand. 4. The fascia expands with injury, causing pressure on underlying nerves and muscles.

3. Bleeding and swelling cause increased pressure in an area that cannot expand. NCLEX

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

3. Presence of a "hot spot" on the cast NCLEX

A client with a short-leg plaster cast complains of an intense itching under the cast. The nurse provides instructions to the client regarding relief measures for the itching. Which client statement indicates an understanding of appropriate measures to relieve the itching? 1. "I can use the blunt part of a ruler to scratch the area." 2. "I can trickle small amounts of water down inside the cast." 3. "I need to obtain assistance when placing an object into the cast for the itching." 4. "I can use a hair dryer on the low setting and allow the cool air to blow into the cast."

4. "I can use a hair dryer on the low setting and allow the cool air to blow into the cast." NCLEX

A client is brought to the emergency department after experiencing a fall. Following radiographic examination, the health care provider (HCP) explains to the client that the leg was fractured, but the break did not extend all the way through the bone. The nurse providing care for this client understands that the HCP is referring to which type of fracture? 1. Open 2. Displaced 3. Complete 4. Incomplete

4. Incomplete NCLEX

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

4. Provides comfort by reducing muscle spasms, provides fracture immobilization, and involves pulleys and wheels NCLEX

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

B. Buck's traction ATI MS

A patient is brought to the emergency room with an injured lower left leg following a fall while rock climbing. The nurse identifies the presence of a fracture based on what cardinal sign of fracture? A. Muscle spasms B. Obvious deformity C. Edema and swelling D. Pain and tenderness

B. Obvious deformity MS workbook

A nurse is preparing a plan of care to prevent a client from developing flexion contractions following a below-the-knee amputation 24 hr ago. Which of the following should the nurse include in the plan of care? A. Limit any type of exercise to the residual limb for the first 48 hr after surgery. B. Position the client prone several times each day. C. Wrap the stump in a figure-eight pattern. D. Encourage sitting in a chair during the day.

B. Position the client prone several times each day. ATI MS

The nurse suspects a neurovascular problem based on assessment of: a. exaggerated strength with movement b. increased redness and heat below the injury c. decreased sensation distal to the fracture site d. purulent drainage at the site of an open fracture

c. decreased sensation distal to the fracture site MS

external fixation

fracture immobilization using pins and wires that are attached to a rigid external frame (ATI) the use of an external frame to stabilize a fracture by attaching skeletal pins through bone fragments to a rigid external support (NCLEX)

stress fracture

occurs in bone that is subjected to repeated stress, such as from jogging or running

hip arthroplasty: pt teaching (5)

-clean incision site daily with soap and water -raised toilet seat -don't cross legs -don't internally rotate the toes -avoid hip flexion >90° (ex: straight backed chair, use a shoe horn)

fat embolism symptoms (7)

-dyspnea -decreased oxygen saturation -chest pain -tachycardia -headache -decreased LOC -confusion

fat embolism

-fat globules from fractures that are distributed into tissues, lungs, and other organs after a traumatic skeletal injury (MS) -fat globules from the bone marrow are released into the vasculature and travel to the small blood vessels, including those in the lungs, resulting in acute respiratory insufficiency and impaired organ perfusion (ATI)

traction: pt teaching (5)

-frequent repositioning -ROM exercises of unaffected joints -deep-breathing exercises -isometric exercises -use of trapeze bar

components of a neurovascular assessment (6)

-pain -sensation -skin temperature -capillary refill -pulses -movement

early signs of compartment syndrome (2)

-pain unrelieved by drugs and out of proportion to the level of injury is one of the 1st indications -paresthesia

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

1. "I need to avoid getting the cast wet." NCLEX

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

1. "I should not use someone else's crutches." 2. "I need to remove any scatter rugs at home." 4. "I need to have spare crutches and tips available." NCLEX

A nurse has provided discharge instructions to a client after a total hip replacement. Which statement by the client indicates a need for further instruction? 1. "I should sit in my recliner when I get home." 2. "I need to keep my legs apart while sitting or lying." 3. "I should try to obtain an elevated toilet seat for use at home." 4. "I should contact the health care provider (HCP) if the incision becomes red or irritated or if I note any drainage."

1. "I should sit in my recliner when I get home." NCLEX

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

1. Clear mentation NCLEX

The nurse is preparing to perform pin site care for a client in skeletal traction. On assessment of the pin site, the nurse notes the presence of serous drainage. Which nursing action would be appropriate? 1. Document the findings. 2. Notify the health care provider (HCP). 3. Remove 2 pounds of weight from the traction. 4. Lift the weights and place them on the bed so that the HCP can assess the client.

1. Document the findings. (small amount of serous oozing is an expected finding) NCLEX

A client is admitted to the nursing unit after a left below-the-knee amputation after a crush injury to the foot and lower leg. The client tells the nurse, "I think I'm going crazy. I can feel my left foot itching." How should the nurse interpret this client statement? 1. A normal response that indicates the presence of phantom limb pain 2. A normal response that indicates the presence of phantom limb sensation 3. An abnormal response that indicates that the client is in denial about the limb loss 4. An abnormal response that indicates that the client needs more psychological support

2. A normal response that indicates the presence of phantom limb sensation NCLEX

The nurse in the hospital emergency department is caring for a client with a fractured arm and is preparing the client for a reduction of the fracture that will be done in the casting room in the emergency department. The nurse should take which actions? Select all that apply. 1. Obtain an anesthesia consent. 2. Administer a prescribed analgesic. 3. Explain the procedure to the client. 4. Obtain informed consent for the procedure. 5. Inform the anesthesiologist of the time of the procedure.

2. Administer a prescribed analgesic. 3. Explain the procedure to the client. 4. Obtain informed consent for the procedure. NCLEX

A client is admitted to the emergency department with an open fracture of the right tibia. What intervention is most appropriate for this client? 1. Apply a tourniquet above the area of bleeding and loosen it every 15 minutes. 2. Check the neurovascular status of the area distal to the extremity. 3. Place the client in a semi-Fowler's position. 4. Remove the client's shoes.

2. Check the neurovascular status of the area distal to the extremity. NCLEX

The nurse is assigned to care for a client in traction. The nurse prepares a plan of care for the client and includes which nursing action in the plan? 1. Ensure that the knots are at the pulleys. 2. Check the weights to ensure that they are off of the floor. 3. Ensure that the head of the bed is kept at a 45- to 90-degree angle. 4. Monitor the weights to ensure that they are resting on a firm surface.

2. Check the weights to ensure that they are off of the floor. NCLEX

The nurse is performing a neurovascular assessment on a client with a cast on the left lower leg. The nurse notes the presence of edema in the foot below the cast. The nurse should make which interpretation about this finding? 1. Arterial insufficiency 2. Impaired venous return 3. Impaired arterial circulation 4. The presence of an infection

2. Impaired venous return NCLEX

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

2. Injury to the brachial plexus nerves NCLEX

The nurse is assigned to care for a client who is in Buck's traction. The nurse prepares a plan of care for the client and includes which nursing action in the plan? 1. Make sure that the knots are at the pulleys. 2. Inspect the skin under the boot at least every 8 hours. 3. Make sure the head of the bed is kept at a 45- to 90-degree angle. 4. Monitor the weights to be sure that they are resting on a firm surface.

2. Inspect the skin under the boot at least every 8 hours. NCLEX

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

2. Numbness and tingling in the fingers (earliest sign is paresthesia, cyanosis and severe pain are late symptoms) NCLEX

The nurse is preparing a plan of care for a client in skin traction. The nurse should monitor for which priority finding in this client? 1. Urinary incontinence 2. Signs of skin breakdown 3. The presence of bowel sounds 4. Signs of infection around the pin sites

2. Signs of skin breakdown NCLEX

The nurse is caring for the client who has skeletal traction applied to the left leg. The client complains of severe left leg pain. The nurse checks the client's alignment in bed and notes that proper alignment is maintained. Which is the priority nursing action? 1. Provide pin care. 2. Medicate the client. 3. Call the health care provider (HCP). 4. Remove 2 pounds of weight from the traction system.

3. Call the health care provider (HCP). (severe pain in a client in skeletal traction may indicate a need for realignment, or the traction weights applied to the limb may be too heavy) NCLEX

The nurse is caring for a client after the application of a plaster cast for a fractured left radius. The nurse should suspect impairment with the neurovascular status of the client's casted extremity if which findings are noted? Select all that apply. 1. Capillary refill is less than 3 seconds 2. Pulses present and with swollen, pink fingers 3. Client report of severe, deep, unrelenting pain 4. Client report of pain as nurse assesses finger movement 5. Client report of numbness and tingling sensation in the fingers

3. Client report of severe, deep, unrelenting pain 4. Client report of pain as nurse assesses finger movement 5. Client report of numbness and tingling sensation in the fingers NCLEX

The nurse is caring for a client at risk for fat embolism because of a fracture of the left femur and pelvis sustained in a fall. The client also sustained a head injury, is comatose, and is unable to communicate verbally. Which assessment findings should the nurse identify as early signs of possible fat embolism? 1. Decreased heart rate and increased restlessness 2. Decreased heart rate and decreased respiratory rate 3. Increased heart rate and adventitious breath sounds 4. Increased heart rate and increased oxygen

3. Increased heart rate and adventitious breath sounds NCLEX

A client has been placed in Buck's extension traction. The nurse can provide for countertraction to reduce shear and friction by performing which action? 1. Using a footboard 2. Providing an overhead trapeze 3. Slightly elevating the foot of the bed 4. Slightly elevating the head of the bed

3. Slightly elevating the foot of the bed NCLEX

The nurse determines that a client's skeletal traction needs correction if which observation is made? 1. Weights are not touching the floor. 2. Weights are hanging free of the bed. 3. Traction ropes rest against the footboard. 4. Traction ropes are aligned in each pulley.

3. Traction ropes rest against the footboard. (ropes must hang free of the bed) NCLEX

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

3. thick, yellow drainage from the pin sites (yellow drainage = infection, other findings are normal) NCLEX

The nurse is performing an assessment on a client after a closed reduction of a fractured right humerus and application of a plaster cast. To assess for signs of compartment syndrome, the nurse should perform which action? 1. Assess the client's cognitive level. 2. Assess the temperature of the cast. 3. Monitor for the presence of drainage or odors on or beneath the cast. 4. Assess capillary refill, temperature, color, and amount of pain in the right hand.

4. Assess capillary refill, temperature, color, and amount of pain in the right hand. NCLEX

The nurse is performing an assessment on a client after a closed reduction of a fractured right humerus and application of a plaster cast. To assess for signs of compartment syndrome, the nurse should perform which action? 1. Assess the client's cognitive level. 2. Assess the temperature of the cast. 3. Monitor for the presence of drainage or odors on or beneath the cast. 4. Assess capillary refill, temperature, color, and amount of pain in the right hand.

4. Assess capillary refill, temperature, color, and amount of pain in the right hand. NCLEX

The nurse is caring for a client with a fractured tibia and fibula. Eight hours after a long leg cast is applied, the client reports a significant increase in pain level even after administration of the prescribed dose of opioid analgesic. What is the initial nursing action? 1. Elevate the casted leg. 2. Contact the health care provider (HCP). 3. Administer another dose of pain medication. 4. Check the neurovascular status of the toes on the casted leg.

4. Check the neurovascular status of the toes on the casted leg. NCLEX

The nurse is caring for a client with a radius fractured across the shaft and bone splintered into fragments. Information about which type of fracture should be included by the nurse in the client's education? 1. Simple fracture 2. Greenstick fracture 3. Compound fracture 4. Comminuted fracture

4. Comminuted fracture NCLEX

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

4. Elevated on pillows continuously for 24 to 48 hours (elevated continuously for 24-48 hrs to minimize swelling and promote venous drainage) NCLEX

The nurse is caring for a client with a long bone fracture at risk for fat embolism. The nurse specifically monitors for the earliest signs of this complication by performing an assessment of which item(s)? 1. The client's mobility status 2. The renal and endocrine systems 3. The cardiovascular and renal systems 4. The neurological and respiratory systems

4. The neurological and respiratory systems (decreased LOC, confusion, dyspnea, decreased SpO2) NCLEX

The nurse is providing instructions to a client regarding ambulation after the application of a fiberglass cast to the lower leg. The nurse determines that the client understands the instructions if the client states that weight bearing on the casted leg can begin at which time period? 1. In 48 hours 2. In 24 hours 3. In approximately 8 hours 4. Within 20 to 30 minutes of application

4. Within 20 to 30 minutes of application NCLEX

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

A. "I will clean the pins twice a day." B. "I will use a separate cotton swab for each pin." C. "I will report loosening of the pins to my doctor." E. "I will report increased redness at the pin sites." ATI MS

A nurse is planning discharge teaching for a client who had a total hip arthroplasty. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Clean the incision daily with soap and water. B. Turn the toes inward when sitting or lying. C. Sit in a straight-backed armchair. D. Bend at the waist when putting on socks. E. Use a raised toilet seat.

A. Clean the incision daily with soap and water. C. Sit in a straight-backed armchair. E. Use a raised toilet seat. ATI MS

A nurse is completing a preoperative teaching plan for a client who is to have a total hip arthroplasty. Which of the following should the nurse include in the teaching plan? (Select all that apply.) A. Encourage complete autologous blood donation B. Sit in a low reclining chair C. Instruct the client roll onto the operative hip D. Use an abductor pillow when turning E. Perform isometric exercises

A. Encourage complete autologous blood donation D. Use an abductor pillow when turning E. Perform isometric exercises ATI MS

A nurse is caring for a client following a below-the-elbow amputation. Which of the following are appropriate actions by the nurse? (Select all that apply.) A. Encourage dependent positioning of the residual limb. B. Inspect for presence and amount of drainage. C. Implement shrinkage intervention of the residual limb. D. Wrap the residual limb in a circular manner using gauze. E. Assess for feelings of body image changes.

A. Encourage dependent positioning of the residual limb. B. Inspect for presence and amount of drainage. C. Implement shrinkage intervention of the residual limb. E. Assess for feelings of body image changes. ATI MS

A nurse is assessing a client who had an external fixation device applied 2 hr ago for a fracture of the left tibia and fibula. Which of the following findings is a manifestation of compartment syndrome? (Select all that apply) A. Intense pain when the left foot is passively moved B. Capillary refill of 3 sec on the client's left toes C. Hard, swollen muscle in the left leg D. Burning and tingling of the client's left foot E. Client report of minimal pain relief following a second dose of opioid medication

A. Intense pain when the left foot is passively moved C. Hard, swollen muscle in the left leg D. Burning and tingling of the client's left foot E. Client report of minimal pain relief following a second dose of opioid medication ATI MS

A patient is admitted with an open fracture of the tibia following a bicycle accident. During assessment of the patient, about what specifically should the nurse question the patient? A. Any previous injuries to the leg. B. The status of tetanus immunization. C. The use of antibiotics in the last month. D. Whether the injury was exposed to dirt or gravel.

B. The status of tetanus immunization. (open fracture has a high risk of infection) MS workbook

purpose of bivalving a cast

Bivalving the cast involves splitting the cast along both sides to allow space for swelling, to facilitate taking radiographs, or to make a half-cast for use as an intermittent splint

When is a fat embolism most likely to occur? a. 24-48 hrs following a fractured tibia b. 36-72 hrs following a skull fracture c. 4-5 days following a fractured femur d. 5-6 days following a pelvic fracture

a. 24-48 hrs following a fractured tibia (initial manifestations of a fat embolism usually occur 24-48 hrs after injury and are associated with fracture of long bones and multiple fractures related to pelvic injuries) MS workbook

A pt with a pelvic fracture should be monitored for: a. changes in urine output b. petechiae on the abdomen c. a palpable lump in the buttock d. sudden increased in blood pressure

a. changes in urine output MS

What is a disadvantage of open reduction and internal fixation (ORIF) of a fracture compared to a closed reduction? a. infection b. skin irritation c. nerve impairment d. complications of immobility

a. infection MS workbook

A patient complains of pain in the food of a leg that was recently amputated. What should the nurse recognize about this pain? a. It is caused by swelling at the incision. b. It should be treated with ordered analgesics. c. It will become worse with the use of a prosthesis. d. It can be managed with diversion because it is psychologic.

b. It should be treated with ordered analgesics. MS workbook

A pt with a fractured right hip has an anterior ORIF of the fracture. What should the nurse plan to do postoperatively? a. ambulate the pt with partial weight bearing by discharge b. position the pt only on the back and the nonoperative side c. get the pt up to the chair on the first postoperative day d. keep the leg abductor pillow on the pt even when bathing

c. get the pt up to the chair on the first postoperative day MS workbook

The pt with osteoporosis had a spontaneous hip fracture. How should the nurse document this before the x-ray results return? a. open fracture b. oblique fracture c. pathologic fracture d. greenstick fracture

c. pathologic fracture (spontaneous fracture at the site of bone disease) MS workbook

A pt with a comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when: a. the pt is unable to tolerate prolonged immobilization b. the pt cannot tolerate the surgery for a closed reduction c. a temporary cast would be too unstable to provide normal mobility d. adequate alignment cannot be obtained by other nonsurgical methods

d. adequate alignment cannot be obtained by other nonsurgical methods MS

A nurse is caring for a client who had an above-the-knee amputation. The client reports a sharp, stabbing type of phantom pain. Which of the following actions should the nurse take? a. facilitate counseling services b. encourage use of cold therapy c. question whether the pain is real d. administer an antiepileptic medication

d. administer an antiepileptic medication (antiepileptics (ex: gabapentin, pregablin) for neuropathic pain) ATI MS

What should the nurse include in discharge instructions for the pt following a hip prosthesis with a posterior approach? a. restrict walking for 2-3 months b. take a bath rather than a shower to prevent falling c. keep the leg internally rotated while sitting and standing d. have a family member put on the pt's shoes and socks

d. have a family member put on the pt's shoes and socks MS workbook

A pt has fallen in the bathroom of the hospital room and reports pain in the upper right arm and elbow. Before splinting the injury, the nurse knows that the priority management of a possible fracture should include which action? a. elevation of the arm b. application of ice to the site c. notification of the health care provider d. neurovascular checks below the site of injury

d. neurovascular checks below the site of injury -sensation, motor function, and pain distal to the injury should be checked before and after splinting to assess for nerve damage, then the HCP is notified -elevation of the limb and application of ice should be instituted after the extremity is splinted MS workbook

A patient with a stable, closed fracture of the humerus caused by trauma to the arm has a temporary splint with a bulky padding applied with an elastic bandage. The nurse suspects compartment syndrome and notifies the physician when the patient experiences: a. increasing edema of the limb b. muscle spasms of the lower arm c. rebounding pulse at the fracture site d. pain when passively extending the fingers

d. pain when passively extending the fingers MS