Chap 42 Review

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

With compartment syndrome, the client can't perform active movement, and pain occurs with passive movement.

A patient complains of pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The patient was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury?

A sprain is an injury to the ligaments and tendons surrounding a joint, usually caused by a wrenching or twisting motion.

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 refers to the death of the bone from insufficient blood supply, typically manifested by complaints of increased pain and decreased function.

Which factor inhibits fracture healing?

Factors that inhibit fracture healing include local malignancy, bone loss, and extensive local trauma.

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

General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation with ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care.

Emergency medical technicians transport a client to the emergency department. They tell the nurse, "He fell from a two-story building. He has a large contusion on his left chest and a hematoma in the left parietal area. He has a compound fracture of his left femur and he's comatose. We intubated him and he's maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag." Which intervention by the nurse has the highest priority?

In this scenario, airway and breathing have been established, so the nurse's priority should be circulation. With a compound fracture of the femur, there is a high risk of profuse bleeding; therefore, the nurse should assess the left leg.

R.I.C.E.

R=rest I= ice C=compression E=elevate

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

Reassure the patient that phantom pain is common

The patient presents to the emergency room with an open fracture of the femur. Which action would the nurse implement to prevent the most serious complication of an open fracture?

The most important complication of an open fracture is infection. Therefore, the wound is covered with a sterile dressing.

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

The client requires additional teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees.

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?

A partial dislocation is referred to as a subluxation.

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

Depressed skull fractures occur as a result of blunt trauma

A client has delayed bone healing in a fractured right humerus. What should the nurse prepare the client for that promotes bone growth?

Delayed union may require surgical interventions to promote bone growth and correct the incorrect union. If necessary, prepare the client for use of electrical stimulation measures that promote bone growth, or for a bone graft.

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?

A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great.

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

Disseminated intravascular coagulation (DIC). DIC is a systemic disorder that results in widespread hemorrhage and microthrombosis with ischemia.

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?

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

Which is a hallmark sign of compartment syndrome?

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

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs.

A fracture is considered pathologic when it

occurs through an area of diseased bone.

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

Buck's traction decreases pain, muscle spasm, and external rotation by immobilizing the hip fracture.

A client presents at an ambulatory clinic with complaints of pain and aching in the lower left leg. After examining the client, a physician determines the client has experienced a strain related to the client's exercise regimen. The treatment plan includes analgesics, rest, and cold and heat therapies. Which guideline should be included in the care plan?

The injury should be managed with cold therapy for the first 24 hours, followed by heat therapy for periods of 15 to 30 minutes. Cold applications should be intermittent to avoid temperature-related injuries to the skin. Physical activities should be restricted for 2 to 5 days depending on the severity of the injury.

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?

The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint. Postoperative total hip replacement clients may be turned onto the unaffected side. The hip may be flexed slightly, but it shouldn't exceed 90 degrees. Maintenance of flexion isn't necessary.

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?

The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing.

Which nursing intervention is appropriate for monitoring the client for the development of Volkmann's contracture?

Volkmann's contracture is a type of acute compartment syndrome that occurs with a supracondylar fracture of the humerus. The nurse assesses neurovascular function of the hand and forearm.

A client was involved in a motor vehicle collision. The client's left arm was severely traumatized in the accident and the client was taken immediately to surgery. Postoperatively, the physician has ordered close monitoring for compartment syndrome. What musculoskeletal structure does compartment syndrome affect?

With compartment syndrome, tissue perfusion in the muscle compartment is compromised secondary to tissue swelling, hemorrhage, or a cast that is too tight. If circulation is not restored, ischemia and tissue anoxia lead to permanent nerve damage, muscle atrophy, and contracture.