Chapter 25: Mechanical Immobilization

A client with a dislocated shoulder has come to the emergency department (ED) in extreme pain. Which type of traction will the nurse prepare to be used?

manual

An older adult is undergoing mechanical immobilization. Which factor is the nurse aware of contributing to the client's increased risk for pressure sores?

diminished tactile sensation

A client with an arm cast and sling is having a routine follow-up appointment to check on the progress of the healing fracture. Which assessment finding requires nursing intervention?

fingers of casted arm are cool to touch

A client who is immobile reports severe pain in the right flank. The physician diagnoses the client with renal calculi. This condition often results from:

increased serum calcium.

A client is having a fiberglass cast applied. The client says to the nurse, "Years ago, I had a plaster cast and it wasn't like this one. Is this better?" What advantages of the fiberglass cast would the nurse cite? Select all that apply.

lightweight porous unaffected by water

The nurse is caring for a client who has a dislocated shoulder. Which type of traction intervention does the nurse anticipate will be used to address this concern?

manual

The nurse is caring for a client with carpal tunnel syndrome. Which type of splint does the nurse anticipate will be ordered?

molded

The nurse is showing a client "petals" that will be applied to a forearm cast. When the client asks, "What are those for?" what teaching will the nurse provide?

moleskin pieces that cover the cast's rough edges

When planning care for a client with an external fixator on the right lower leg, ankle, and foot, which nursing diagnosis will the nurse assign to address the assessment findings of reddened skin and tenderness at the pin sites, temperature of 100°F (37.77°C), and foot warm to the touch?

risk for Infection

A client is about to have a cast applied to his left arm. The nurse would alert the client to what as the cast is applied?

sensation of warmth or heat with application

A home care nurse is assessing a client in the home. The client had a cerebrovascular accident and has right side paralysis. After 6 weeks of rehabilitation, the client has increasing mobility when:

she can lift the right arm ½ inch.

What are examples of orthoses? Select all that apply.

splints immobilizers braces

A flexion contracture usually occurs because of inactivity and:

tensor muscles being stronger that flexors.

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene?

weights hanging and touching the floor

The nurse tells a newly casted client that "petals" will be applied. What is the appropriate nursing response when the client asks, "What are petals?"

"Pieces of moleskin that cover rough edges of the cast."

The nurse is preparing a client with an arm fracture for plaster casting. The client reports, "I forgot to tell the provider that I have chemical and environmental allergies." What is the appropriate initial nursing response?

"Plaster casts have a lower incidence of allergic reaction."

The nurse is caring for a client who is in skeletal traction. To prevent the complication of skin breakdown in a client with skeletal traction, what preventive measure would the nurse implement?

Assess the pin insertion site every 8 hours

The nurse is teaching the parent of a child who has been casted after a foot fracture how to assess circulation in the affected limb at home. Which teaching will the nurse provide? Select all that apply.

Compare skin color between affected and non-affected limb. Compress the toenail beds and look for color to return. Touch both feet and assess for temperature differences. Have child close eyes while parent touches foot to see if child notices.

The school nurse has been called to the playground to care for a 12-year-old child who fell from the top of the monkey bars. The client's left leg and ankle are deformed, and bleeding is coming from an open wound. What is the appropriate nursing intervention? Select all that apply.

Contact 9-1-1. Place a clean towel over the wound. Put a blanket over the client.

The nurse is caring for a client who is on strict bed rest. Her medical history includes partial paralysis from a stroke suffered several years ago. There is also evidence of early dementia. The nurse correctly recognizes the client is at an increased risk for which complication?

Muscle atrophy

A client with a recent fracture is suspected of having compartment syndrome. Data findings may include which symptoms?

Inability to perform passive movement, pain with active movement

A client with a right tibial fracture is being discharged home after having a cast applied. The nurse gives instructions to the client and family. What instruction should the nurse provide in relationship to the client's cast care?

Keep your right leg elevated above heart level.

The nursing instructor in the skills lab at the nursing school is showing a group of nursing students how to apply traction. What is an appropriate example of proper traction use?

Knots in the rope should not be resting against pulleys.

The nurse is caring for a client who sustained a mild neck sprain in a motor vehicle accident. What teaching regarding the use of a cervical collar will the nurse include?

Limit neck and head movements.

The nurse is caring for an older adult client who has pain and loss of function associated with arthritis. Which nursing teaching is appropriate?

Physical and occupational therapy may be initially helpful.

A nurse is providing care for a client in skin traction. What is a recommended guideline?

Place the client in a supine position with the foot of the bed elevated slightly.

The nurse is caring for a client who has a hip spica. Which nursing intervention is appropriate?

Provide fracture pan as needed.

The nurse is caring for a client with a hip spica cast. Which nursing intervention is appropriate to assist the client with elimination?

Provide fracture pan as needed.

The nurse is teaching a client how to care for a fiberglass cast. Which teaching point will the nurse include?

Sharp edges may irritate skin.

A nurse is preparing to apply an emergency splint and is placing a clean covering to the wounded area first. What is the rationale for the nurse's action?

Such a covering absorbs blood and prevents dirt and additional pathogens from entering

A nurse is applying an ankle-foot orthosis to a client. What are the functions of this orthopedic device? Select all that apply.

Support body part. Align body part. Correct deformities.

The nurse is preparing a client for cast removal. Which teaching will the nurse provide to the client?

The cast will be removed with an electric cast cutter.

A nurse has assisted with the application of a cervical collar. What would indicate that the application is correct?

The client is breathing and swallowing without effort.

A nurse is caring for a male client who has recently been fitted with a cast following a tibial fracture. Which assessment findings would be suggestive of neurovascular dysfunction?

The client is unable to wiggle his toes on demand.

The nurse is caring for a client who has had a shoulder spica made of plaster of Paris applied. Which teaching will the nurse provide to the client?

The client should expect to feel that the cast is hot and heavy.

The telehealth nurse is speaking with a parent whose child jumped off a couch and now is crying and holding the forearm. Which teaching will the nurse provide regarding emergency splinting?

Use a rigid splinting material.

The nurse is caring for a client who has a long leg cast applied after surgery yesterday. The client is using a patient-controlled analgesia (PCA) device appropriately. At 1700, the client reports pain of "8" on a 1-10 scale. At 1900, pain has decreased to a "7". At 2100, the client reports pain of a "6". Which nursing intervention is appropriate?

Utilize prn doses of pain control medication.

A nurse has to perform pin site care. Place the steps of the skill in the correct sequence from first to last.

Wash your hands or perform an alcohol-based hand rub. Don gloves. Open the package containing cotton-tipped applicators without touching the applicator tips. Pour enough cleansing agent to saturate the dry applicators while holding them over a basin or wastebasket. Cleanse the skin at the pin site moving outward in a circular manner. Discard soiled supplies in an enclosed, lined container.

The client was placed in a long arm cast after fracturing the humerus. Twelve hours after the application of the cast, the client tells the nurse that his arm hurts. Analgesics do not relieve the pain. What would be the most appropriate nursing action?

preparing the client for cast removal or bivalving of the cast

An older adult man who suffered a hip fracture and is 1 day postoperative is to receive heparin 5,000 units subcutaneous daily. This is administered to:

prevent deep vein thrombosis.

A client has a knee injury, and the nurse practitioner prescribes the use of a brace to reduce the severity. The nurse knows that the type of brace the client is most likely using is:

prophylactic brace.

The nurse is caring for a client in skeletal traction. What should the nurse tell the client to avoid doing in order to prevent bony fragments from moving against one another?

turning side to side

The nurse is caring for a 16-year-old client who is in skeletal traction following a motor vehicle accident. The client avoids using the urinal and bedpan because they "embarrass him." The client's temperature is 101.5°F and the client's blood pressure and pulse are elevated. What would the nurse suspect?

urinary infection

A client reports pain in the casted leg. The nurse has administered analgesics and elevated the limb. Thirty minutes after administering the analgesics, the client states the pain is unrelieved. This may be a sign of:

compartment syndrome.

The nurse is caring for a client who sustained an ankle fracture in a skiing accident this morning. After surgery, the leg and ankle were casted. At 1500, the client reports pain of "5" on a 1-10 scale. At 1700, pain has increased to a "7" despite pain control interventions. At 1900, the client reports pain of a "9" even following opioid medication administration. Which nursing intervention is appropriate?

Contact the health care provider.

The nurse is caring for a client who had a cast applied yesterday for a tibia fracture. When the client returns today with swelling in that extremity, for which procedure does the nurse prepare?

bivalving of the cast

A client with severe arthritis needs temporary immobilization of the wrist and hand. Which type of cast does the nurse anticipate will be ordered?

cylinder bivalve

Which type of cast encloses the trunk and a lower extremity

hip spica

A client was fitted with a cast this morning after fracturing the left ulna and radius in a workplace accident. Which actions should the nurse prioritize in the care of this client?

assessing the neurovascular status of the client's hand

A client with an unstable patella has seen the health care provider to discuss options to provide stability to this joint. Which type of immobilizer does the nurse anticipate applying?

functional brace

While preparing a client with a forearm fracture for casting, the nurse washes and dries the skin. Which nursing action is next?

covering arm with stockinette

A client must wear a cervical collar and asks the nurse how long she will have to use the device. Which time frame would the nurse state?

10 to 14 days

The health care provider has just applied a fiberglass cast to a client with a forearm fracture. How long will the nurse assure that the client holds the extremity in place while the cast dries?

15 minutes

A teenager is having a plaster cast applied. The client's mother asks how long it will take for the cast to dry. What response from the nurse is correct?

24 to 72 hours

The nurse is helping to apply an arm sling for a client with an injured elbow. How many degrees of flexion is the maximum? Record your answer using a whole number

90

A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify what as an example of skin traction?

Buck's

The nurse is caring for a client who sustained a mild neck sprain while playing football. What teaching regarding the use of a cervical collar will the nurse include?

Limit neck and head movements.