Chapter 51 Adaptive Quizzing

A patient is recovering from an above-knee amputation resulting from peripheral vascular disease. Which statement indicates that the patient is coping well after the procedure?

"It will take me some time to get used to this"

What is the appropriate minimum weight of the pulling force in skeletal traction?

15 pounds

For rotator cuff injuries, providers generally take a conservative approach. If a patient has a partial-thickness tear, how much time is allowed for conservative treatment before surgical repair?

3 to 6 months

A 70-year-old patient has an infected tibial fracture. What is the estimated healing time?

90 days

A patient presents with pain in the front of the knee. The patient reports being an avid runner. What will the nurse be most likely to suggest?

A brace and nonsteroidal antiinflammatory drugs (NSAIDs)

Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture?

A hematoma forms at the site of the fracture

Which condition can manifest in a patient undergoing fluoroquinolone therapy?

Achilles tendinopathy

What are the important aspects of emergency care in a patient who has a sports-related injury? Select all that apply.

Application of ice intermittently for 24 to 48 hours; Immobilization of the joint until spinal cord injury is ascertained; Assessment of the neurovascular status in the area distal to the injury

The nurse admits an older adult patient who sustained a left hip fracture and is in considerable pain. The nurse anticipates that the patient will be placed in which type of traction?

Buck's traction

A patient reports a history of wrist pain after an attempt to break a fall by landing on the heel of the hand with an extended wrist. Which type of fracture should the nurse suspect?

Colles' fracture

Arrange the sequence of events, in their order of their occurrence, pertaining to the biochemical theory for fat embolism.

Degradation of fat emboli into free fatty acids Capillary leakage Lipid and platelet aggregation Clot formation

What consequence of excessive wrist extension may result in carpal tunnel syndrome?

Increased pressure in the lower portion of the carpal tunnel

The nurse instructor is educating nursing students about compartment syndrome. What statement made by a nursing student indicates a need for further instruction?

It causes an absence of pulses

What is true regarding the Canadian Centre for Occupational Health and Safety with respect to health care organizations?

It requires work settings to have joint health and safety committees in which employees are actively involved in setting safety standards.

What statements about amputation are correct? Select all that apply.

Lisfranc and Chopart amputations are types of midfoot amputations; In a Syme amputation, most of the foot is removed but the ankle remains; lower extremity amputations are more common than upper extremity amputations

A 70-year-old male patient who underwent an open reduction internal fixation (ORIF) surgery experiences a seizure after 24 hours. Which drug can cause seizures related to its toxic metabolites?

Meperidine

Which is a positive finding of the Phalen's maneuver?

Paresthesia of the palmar side of the thumb, index finger, middle finger, and half of the ring finger

Which type of traction is used to correct bone deformities of the lower extremities?

Russell's traction

Which intervention does the nurse suggest to a patient with a leg amputation to help cope with loss of the limb?

Talking with an amputee close to the patient's age who has had the same type of amputation

Which are benefits of external fixation of an open fracture when compared to other surgical techniques? Select all that apply.

There is minimal blood loss compared with internal fixation. It carries a low risk for the development of pin-site infection. The device maintains alignment in closed fractures that will not maintain position in a cast. The device allows early ambulation and exercise of the affected body part while relieving pain.

A patient experiences paresthesia when the primary health care provider slightly taps over the median nerve on the wrist. Which finding is observed in the patient?

Tinel's sign

Why is carpal tunnel syndrome (CTS) beginning to be found in much younger patients than previously?

`the use of handheld mobile devices has increased among children

Which individual has the highest chance of developing carpal tunnel syndrome (CTS)?

a 60-year-old female

Which patient is at the highest risk for a fatigue fracture?

a patient who runs every day

A patient with a pelvic fracture is advised to undergo external fixation. Which part of the pelvis might have been involved in the fracture?

acetabulum

A primary health care provider advises a patient to avoid wearing high heels. Which traumatic condition does the nurse suspect in the patient?

achilles tendinopathy

Which condition is effectively treated with rest, ice, compression, and elevation (RICE)?

achilles tendinopathy

A patient who recently suffered a broken tibia presents with edema, a great deal of pain, pale skin, and a weakened pulse. Upon palpation, the area is noted to be tense. What is most likely the concern?

acute compartment syndrome

Which bone fracture complication is also known as ischemia-edema cycle?

acute compartment syndrome

The nurse is caring for a patient with a tibial fracture. For which complication common in a fracture of this type should the nurse monitor the patient?

acute compartment syndrome (ACS)

The nurse refers a patient with an amputation and the patient's family to which community resource?

amputee coalition of America

A patient's short-leg cast has been removed. What should the nurse teach the patient about caring for the extremity after cast removal?

apply elastic bandages around the extremity

A basketball player falls, landing on the outstretched right hand. The player reports feeling a popping sensation upon impact, and now the area of the injury is bruised and swollen. Based on this information, what does the team medical staff most likely direct the player to do in the first 48 hours following the injury?

apply ice and use compression

The nurse is caring for a patient who underwent kyphoplasty. Which nursing intervention is beneficial to the patient?

applying ice pack to the insertion site

The nurse is creating a nursing plan for management of a pelvic fracture. For which complications will the nurse monitor this patient? Select all that apply.

arterial bleeding; blood volume loss; abdominal rigidity; blood in urine and stool

The nurse prepares to perform a neurovascular assessment on a patient with closed multiple fractures of the right humerus. Which technique does the nurse use?

assess sensation of the right upper extremity

A patient's left arm is placed in a plaster cast. Which assessment does the nurse perform before the patient is discharged?

assess that the cast is dry

What is the first step in emergency care of a patient with an extremity fracture?

assessing the patient's airway, breathing, and circulation

How is the Tinel sign diagnostic test for carpal tunnel syndrome (CTS) performed?

by tapping lightly over the area of the median nerve in the wrist

A nurse is monitoring the blood pressure of a patient with gout. Upon inflating the cuff, the patient experiences pain and numbness in the wrist. Which musculoskeletal injury does the nurse suspect in the patient?

carpal tunnel syndrome (CTS)

Which syndrome may result in the compression of the median nerve?

carpal tunnel syndrome (CTS)

A 73-year-old patient is being discharged after falling and fracturing the radius and ulna. What can the nurse tell the patient regarding the length of healing time?

complete healing may last three months or longer

Which complication of fractures can be treated with minimally invasive surgical sympathectomy?

complex regional pain syndrome

A patient who had an open reduction of the ankle complains of intense, burning pain. The primary health care provider instructs the nurse to intravenously administer phentolamine. What condition is the health care team likely treating?

complex regional pain syndrome (CRPS)

The nurse is caring for a patient after a fracture. Which complication of fractures manifests as a clinical triad of sensory perception abnormalities, motor dysfunction such as paresis and muscle spasm, and autonomic nervous system abnormalities?

complex regional pain syndrome (CRPS)

Which complication resulting from a fracture might necessitate the use of an implanted device to block pain perception?

complex regional pain syndrome (CRPS)

In a patient with compartment syndrome, what is the physiologic change that causes pallor?

decreased oxygen to tissues

The nurse is caring for a patient with complex regional pain syndrome (CRPS). Which clinical sign of CRPS is a manifestation of autonomic nervous system dysfunction seen in this complication?

edema

A patient has a short-leg cast following a fracture of the ankle. What does the nurse teach the patient about managing the fracture?

elevate the affected leg on several pillows

Which are initial nursing interventions for a patient with a distal radius fracture? Select all that apply.

elevate, immobilize, remove any jewelry on the affected side; perform a neurovascular assessment on the upper extremity

A patient who underwent therapy for carpal tunnel syndrome (CTS) reports prolonged periods of pain and numbness. Which therapeutic procedure is associated with recovery from this procedure?

endoscopic carpal tunnel release (ECTR)

The nurse is caring for a patient with Buck's traction. What care should the nurse provide for this patient?

ensure the weights are freely hanging at all times

A patient is in traction after a major leg injury. What nursing care is necessary for the patient? Select all that appl

ensure the weights are freely hanging at all times; inspect the traction equipment every 8-12 hours

A 40-year-old patient who is 36 hours into recovering from a fractured pelvis begins experiencing hypoxemia, dyspnea, and tachypnea. For which complication should the nurse first assess the patient?

fat embolism

When differentiating between fat embolism and blood clot embolism, which statement is true?

fat embolism is more likely to occur with fractures of the long bones

A 30-year-old patient suffers a pelvic fracture. His partial oxygen concentration (PaO 2) drops to 70 mm Hg. There is an increase in the erythrocyte sedimentation rate (ESR) and serum lipid levels. The serum calcium level drops to 7 mg/dL. Which complication should the nurse suspect?

fat embolism syndrome (FES)

Athletes are likely to experience which type of fracture?

fatigue

Which stage of bone healing occurs in a patient 3 days to 2 weeks after a fracture?

fibrocartilage formation

A nurse is preparing a presentation on carpal tunnel syndrome (CTS) to be given to a group of employees in an office. Which statement does the nurse need to revise before finalizing the presentation?

for the most appropriate positioning, set the height of your chair 30 in away from the floor

A patient has a fractured tibia. Arrange the stages of bone healing in the order they occur.

formation of hematoma; formation of fibrocartilage; formation of callus; resorption of callus; consolidation and remodeling

A patient has a Buck extension traction. What type of injury does the patient most likely to have?

fracture of the hip before surgery

Which musculoskeletal trauma occurs after minimal trauma to a bone that has been weakened due to disease?

fragility fracture

A surgical repair was done shortly after injury in a patient with a rotator cuff injury using arthroscopy. What could a presurgical magnetic resonance imaging (MRI) of the shoulder reveal?

full-thickness tear

Which occupational activity predisposes a person to carpal tunnel syndrome (CTS)?

grasping during wrist flexion

Which condition may increase the risk for developing acute carpal tunnel syndrome (CTS)? Select all that apply.

hand burns; colles' fracture of the wrist

Which topics are included in patient teaching following a leg amputation? Select all that apply.

how to wrap the limb; range-of-motion exercises; how to turn independently if possible; exercises to prepare the limb for prosthesis; how to inspect the area for signs of inflammation or skin breakdown

The nurse is educating a group of people at a community center about emergency care for physical trauma. What should the nurse teach this group? Select all that apply.

immobilize the extremity; cut the clothing over the affected area; call 911 then assess for airway, breathing, and circulation

Which type of fracture does not divide the bone into two portions because the break is through only part of the bone?

incomplete

Which physiologic change related to compartment syndrome is responsible for symptoms of flexed posture and unequal pulses in a patient?

increased production of lactic acid

A student nurse is caring for an older adult who is recovering from hip replacement. The patient has recently spiked a high temperature and appears confused. For which complication should the nurse assess this patient?

infection

Which complications can result from a fracture? Select all that apply.

infection; hemorrhage; crush syndrome; acute compartment syndrome

Which clinical sign of complex regional pain syndrome (CRPS) does the nurse know to be a manifestation of the sensory perception abnormalities seen in this syndrome?

intense burning pain

The nurse uses a hand brace to immobilize the wrist of a patient who has undergone surgery for carpal tunnel syndrome. What should the nurse explain to the patient about the hand brace?

it helps to provide relief from pain

The nurse manager is observing a nurse caring for a patient after surgery for carpal tunnel release. Which statement made by the nurse requires correction?

it's important for you to keep your fingers as still as possible the first day after surgery

An older adult patient has had a right open reduction and internal fixation (ORIF) of a fractured hip. Which intervention does the nurse implement for this patient?

keep the patient's heels off the bed at all times

When checking a patient with fractures, a wound, and extensive soft tissue damage for signs of infection, which results indicate that there is no infection present? Select all that apply.

lack of fever, negative wound culture, no increase in white blood cell count

What is the major concern related to pelvic injury?

loss of blood volume

What is an early manifestation of fat embolism syndrome?

low arterial oxygen

Carpal tunnel syndrome (CTS) occurs when which nerve in the wrist is compressed?

median

An older adult patient is undergoing treatment for a fracture. Which pain medication must be avoided in this patient?

meperidine

A patient has undergone a kyphoplasty. What discharge teaching should the nurse provide to the patient and family?

monitor the puncture site for infection

What intervention is most commonly used to treat strains?

muscle relaxant

Which finding helps in assessing the motor changes of a patient with carpal tunnel syndrome (CTS)?

muscle weakness

The nurse is taking the medical history of a patient. Which patient statements indicate a likelihood of carpal tunnel syndrome (CTS)? Select all that apply.

my wrist and fingers feel numb; i have severe pain in my wrist at night; i don't have much sensation around my wrist

Which complication is associated with compartment syndrome?

myoglobinuria renal failure

A patient with a rotator cuff injury has undergone surgery. During analgesia, the peripheral nerve was blocked. What complication may be seen in the patient?

numbing feeling of the arm

To which resource should the nurse refer the patient to for upper extremity rehabilitation after trauma?

occupational therapy

After rotator cuff surgery, when are pendulum exercises typically started?

on the third postoperative day

Which type of trauma increases a patient's risk for hospital-acquired infection?

open fractures

A rock climber has sustained an open fracture of the right tibia after a 20-foot fall. The nurse plans to assess the patient for which potential complications? Select all that apply.

osteomyelitis; fat embolism syndrome (FES); acute compartment syndrome (ACS)

Which condition is the biggest risk factor for hip fracture?

osteoporosis

Which motor clinical manifestation may be seen in a patient with complex regional pain syndrome (CRPS)?

paresis

The serum calcium level of a patient with a femoral fracture is 12 mg/dL. What type of fracture does the nurse suspect that the patient has?

pathologic fracture

Which type of traction is used for strain or sprain in the lower back?

pelvic belt

What manifestation is usually seen in fat embolism but not in blood clot embolism?

petechiae

A patient who has severe peripheral vascular disease resulting in an above-the-knee amputation two months ago describes intense burning pain, numbness and tingling. The patient reports the symptoms worsen with exhaustion and stress. What is the patient most likely experiencing?

phantom limb pain

Sensation that is felt in an amputated part immediately after surgery is known as which of the following?

phantom limb pain

A chemical sympathetic nerve block may be used to manage complex regional pain syndrome (CRPS). Which drug, administered intravenously, is used to block sympathetic nerve receptors?

phentolamine

Which statements are true regarding the various types of casting materials for immobilization? Select all that apply.

plaster is not commonly used for casting; fiberglass can dry and become rigid in minutes

Which long-term drug therapy increases the risk of developing ischemic bone necrosis?

prednisone

The nurse anticipates providing collaborative care for a patient with a traumatic amputation of the right hand with which health care team members? Select all that apply.

psychologist; physical therapist; occupational therapist

Which part of the pelvis is non-weight-bearing?

pubic rami

Which condition may be detected by using the drop arm test?

rotator cuff injury

A doctor is performing a closed reduction on a simple fracture. During the procedure, the nurse notices that the patient's end-tidal carbon dioxide levels falls to 30 mm Hg, and the respiratory rate calls to 10 breaths/minute. What is the best response?

rub the patient's sternum and encourage breathing

Which statement is true regarding the types of traction used for musculoskeletal trauma of the lower extremities?

russell's traction is used for fractures of the hip

How is a partial-thickness tear generally manifested in a patient with a rotator cuff injury?

severe pain

In which positions can the nurse assess a patient with a shoulder or upper arm fracture? Select all that apply.

sitting, standing

When using a hand brace to treat carpal tunnel syndrome (CTS), the occupational therapist (OT) will often put the wrist in which position?

slight extension

Which type of fracture may occur when a person attempts to break a fall by landing on the heel of the hand when the wrist is flexed?

smith fracture

Which fracture is most likely to be treated with implantation of a genetically engineered substance?

spine

A patient with bone cancer is most susceptible to what type of fracture?

spontaneous fracture

What is the excessive stretching of a ligament?

sprain

In which stage of bone healing is callus formed?

stage 3

What is the excessive stretching of a muscle or tendon?

strain

A patient is being educated on the prevention of carpal tunnel syndrome (CTS). What is a measure the nurse can suggest to help prevent CTS?

stretching the fingers periodically

What might be the consequence of early ambulation of a patient who underwent open reduction internal fixation (ORIF) surgery?

surgical site healing

Which is true of partial-thickness rotator cuff tears?

they are more painful than full-thickness tears

The nurse is educating a patient who is scheduled for endoscopic carpal tunnel release (ECTR) surgery for carpal tunnel syndrome (CTS). Which statement made by the patient shows understanding of the procedure?

this surgery will require a small incision, but the pain might be worse than it would be with open surgery

A patient sustains a tibial fracture, and a cast is applied. The primary health care provider advises that a window is cut on the cast. What is the objective of this action?

to inspect the skin

A patient is examined in a sitting or standing position for what type of fracture?

upper arm

A patient has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction does the nurse include in this patient's teaching plan?

use pain medication as prescribed to control pain

A patient has a grade III compound fracture of the right tibia. To prevent infection, which intervention does the nurse implement?

use strict aseptic technique when cleaning the site

What are the major concerns related to pelvic fractures? Select all that apply.

venous oozing; arterial bleeding; hypovolemic shock

Which procedure to treat a vertebral compression fracture involves injecting bone cement through the skin directly into the fracture site, allowing the patient to go home the next day?

vertebroplasty

Which group of patients is most likely to experience carpal tunnel syndrome (CTS)?

women over 50