Chapter 65 - Fractures of the Hip (Questions)

The nurse is preparing a client with lower leg fracture and an external fixation device in place for discharge. Which of the following information should the nurse include in the discharge teaching? a. "You will need to assess and clean the pin insertion sites daily." b. "The external fixator can be removed during the bath or shower." c. "You will need to remain on bed rest until bone healing is complete." d. "Prophylactic antibiotics are used until the external fixator is removed."

ANS: A Pin insertion sites should be cleaned daily to decrease the risk for infection at the site. An external fixator allows the client to be out of bed and avoid the risks of prolonged immobility. The device is surgically placed and is not removed until the bone is stable. Prophylactic antibiotics are not routinely given when an external fixator is used.

Before assisting a client with ambulation on the day after a total hip replacement, which of the following actions is most important for the nurse to implement? a. Administer the ordered oral opioid pain medication. b. Instruct the client about the benefits of ambulation. c. Ensure that the incisional drain has been discontinued. d. Change the hip dressing and document the wound appearance.

ANS: A The client should be adequately medicated for pain before any attempt to ambulate. Instructions about the benefits of ambulation may increase the client's willingness to ambulate, but decreasing pain with ambulation is more important. The presence of an incisional drain or timing of dressing change will not affect ambulation.

The nurse is caring for a client who has had an open reduction and internal fixation (ORIF) of left lower leg fractures who indicates constant severe pain in the leg which is unrelieved by the prescribed morphine. Pulses are faintly palpable and the foot is cool. Which of the following actions should the nurse take next? a. Notify the health care provider. b. Assess the incision for redness. c. Reposition the left leg on pillows. d. Check the client's blood pressure.

ANS: A The client's clinical manifestations suggest compartment syndrome and delay in diagnosis and treatment may lead to severe functional impairment. The data do not suggest problems with blood pressure or infection. Elevation of the leg will decrease arterial flow and further reduce perfusion.

The nurse is caring for a client who had hip replacement surgery using the posterior approach. Which of the following client actions requires rapid intervention by the nurse? a. The client uses crutches with a swing-to gait. b. The client leans over to pull shoes and socks on. c. The client sits straight up on the edge of the bed. d. The client bends over the sink while brushing the teeth.

ANS: B Leaning over would flex the hip at greater than 90 degrees and predispose the client to hip dislocation. The other client actions are appropriate and do not require any immediate action by the nurse to protect the client.

The nurse is caring for a client who is on bed rest after having a complex pelvic fracture. Which of the following assessment findings is most important to report to the health care provider? a. The client states that the pelvis feels unstable. b. Abdominal distention is present and bowel tones are absent. c. There are ecchymoses on the abdomen and hips. d. The client complains of pelvic pain with palpation.

ANS: B The abdominal distention and absent bowel tones may be due to complications of pelvic fractures such as paralytic ileus or hemorrhage or trauma to the bladder, urethra, or colon. Pelvic instability, abdominal pain with palpation, and abdominal bruising would be expected with this type of injury.

The nurse is caring for a client who has been hospitalized for 3 days with a hip fracture who has sudden onset shortness of breath and tachypnea. The client tells the nurse, "I feel like I am going to die!" Which of the following actions should the nurse take first? a. Stay with the client and offer reassurance. b. Administer the prescribed PRN oxygen at 4 L/minute. c. Check the client's legs for swelling or tenderness. d. Notify the health care provider about the symptoms.

ANS: B The client's clinical manifestations and history are consistent with a fat embolus, and the nurse's first action should be to ensure adequate oxygenation. The nurse should offer reassurance to the client, but meeting the physiological need for oxygen is a higher priority. The health care provider should be notified after the oxygen is started and pulse oximetry and assessment for fat embolus or venous thrombo-embolism (VTE) are obtained.

The nurse is preparing to assist a client who has had an open reduction and internal fixation (ORIF) of a hip fracture out of bed for the first time. Which of the following actions should the nurse take first? a. Use a mechanical lift to transfer the client from the bed to the chair. b. Check the postoperative orders for the client's weight-bearing status. c. Avoid administration of pain medications before getting the client up. d. Delegate the transfer of the client out of bed to an unregulated care provider (UCP).

ANS: B The nurse should be familiar with the weight-bearing orders for the client before attempting the transfer. Mechanical lifts are not typically needed after this surgery. Pain medications should be given, since the movement is likely to be painful for the client. The RN should supervise the client during the initial transfer to evaluate how well the client is able to accomplish this skill.

The nurse is counselling a client about ways to prevent fractures. Which of the following information should the nurse include? a. Tack down throw rugs in the home. b. Most falls happen outside the home. c. Buy shoes that provide good support and are comfortable to wear. d. Range-of-motion exercises should be taught by a physical therapist.

ANS: C Comfortable shoes with good support will help decrease the risk for falls. Throw rugs should be eliminated, not just tacked down. Activities of daily living provide range of motion exercise; these do not need to be taught by a physical therapist. Falls inside the home are responsible for many injuries.

The nurse is preparing a client for discharge 4 days after insertion of a femoral head prosthesis using a posterior approach. Which of the following client statements indicates a need for additional discharge instructions? a. "I should not cross my legs while sitting." b. "I will use a toilet elevator on the toilet seat." c. "I will have someone else put on my shoes and socks." d. "I can sleep in any position that is comfortable for me."

ANS: D The client needs to sleep in a position that prevents excessive internal rotation or flexion of the hip. The other client statements indicate that the client has understood the teaching.