Med Surg 2-- Orthopedic Seminar

The nurse prepares a teaching plan for a client about crutch walking using a two point gait pattern. Which of the following should the nurse include? a. Advance a crutch on one side and then advance the opposite foot; repeat on the opposite side b. Advance a crush on one side and simultaneously advance the bear weight on the opposite foot; repeat on the opposite side c. Advance both crutches together and then follow by lifting both lower extremities to the level of the crutches d. Advance both crutches together and then follow by lifting both lower extremities past the level of the crutches

2

A client has a Pearson attachment on the traction setup. Which of the following is the purpose of this attachment? 1. To support the lower portion of the leg. 2. To support the thigh and upper leg. 3. To allow attachment of the skeletal pin. 4. To prevent flexion deformities in the ankle and foot.

a

Because a client has a Thomas splint, the nurse should assess the client regularly for which of the following? a. Signs of skin pressure in the groin area b. Evidence of decreased breath sounds c. Skin breakdown behind the heel d. Urine retention

a

The client has just had a total knee replacement for severe osteoarthritis. Which of the following assessment findings should leave the nurse to suspect possible nerve damage a. Numbness b. Bleeding c. Dislocation d. Pinkness

a

A client has severe arterial occlusive disease and gangrene of the left great toe. Which of the following findings is expected? a. Edema around the ankle b. Loss of hair on the lower leg c. Thin, soft toenails d. Warmth in the foot

b

An older adult patient has fallen in her home and is brought to the ER by ambulance with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning assessments during the patient's presurgical care, the nurse should be aware of the patient's heightened risk of what complication? a. Osteomyelitis b. Avascular necrosis c. phantom pain d. septicemia

b

The client with a fractured femur is upset and agitated about her injury and its treatment. She says, "how can I stay like this for weeks? I can't even move!" Which of the following is the most important nursing diagnosis? a. Impaired physical mobility related to traction b. Ineffective coping related to prolonged immobilization c. Deficient diversional activity related to prolonged hospitalization d. Activity intolerance related to impaired mobility

b

The nurse is assessing a client for neurologic impairment after a total hip replacement. Which of the following would indicate impairment in the affected extremity? a. Decreased distal pulse b. Inability to move c. Diminished capillary refill d. Coolness to the touch

b

The nurse is planning care for a client with osteomyelitis. The client is taking an anabiotic, but the infection has not resolved. The nurse should advise the client to do which of the following? a. Use herbal supplements b. Eat a diet high in protein and vitamins C and D c. Ask the healthcare provider for a change of antibiotics d. Encourage frequent passive range of motion to the affected extremity

b

The orthopedic nurse should assess for signs and symptoms of Volkman's contracture if a patient has fractured which of the following bones? a. Femur b. Humerus c. Radial head d. Clavicle

b

Which of the following interventions would be least appropriate for a client who is in a double hip spica cast? a. Encouraging the intake of cranberry juice b. Advising the client to eat large amounts of cheese c. Establishing regular times for illumination d. Having the client dangle at the bedside

b

Which of the following is the most appropriate nursing intervention to facilitate healing in a patient who has suffered a hip fracture? a. Administer analgesics as required b. Place a pillow between the patient's legs when turning c. maintain prone positioning at all times d. encourage internal and external rotation of the affected leg

b

The client in balanced suspension traction is transported to surgery for closed reduction and internal fixation of his fractured femur. Which of the following should the nurse do when transporting the client to the operating room? 1. Transfer the client to a cart with manually suspended traction. 2. Call the surgeon to request an order to temporarily remove the traction. 3. Send the client on his bed with extra help to stabilize the traction. 4. Remove the traction and send the client on a cart.

c

A client with a fractured develops compartment syndrome. Which of the following signs should alert the nurse to impending organ failure? a. Crackles b. Jaundice c. Generalized edema d. Dark, scanty urine

d

A client with a hip fracture has undergone surgery for insertion of a femoral head prosthesis. Which of the following activities should the nurse instruct the client to avoid? a. Crossing legs while sitting down b. Sitting on a raised commode seat c. Using an abductor splint while lying on the side d. Rising straight from a chair to a standing position

a

A nurse is caring for a patient who has suffered a hip fracture and he will require an extended hospital stay. The nurse should ensure that the patient does which of the following in order to prevent common complications associated with a hip fracture? a. Avoid requesting analgesia unless pain becomes unbearable b. Use supplementary oxygen when transferring or mobilizing c. Increase fluid intake and perform prescribed foot exercises d. Remain on bedrest for 14 days or until instructed by an orthopedic surgeon

c

A client in the post anesthesia care unit with a left below the knee amputation has pain in her left big toe. Which of the following should the nurse do first? a. Tell the client it is impossible to feel the pain b. Show the client that the toes are not there c. Explain to the client that her pain is real d. Give the client the prescribed opioid analgesic

d

Radiographs of a boy's upper arm show that the humerus appears to be fractured on one side and slightly bent on the other. This diagnostic result suggests what type of fracture? A) Impacted B) Compound C) Compression D) Greenstick

d

A nurse is caring for a patient who had a right below the knee amputation (BKA). The nurse recognizes the importance of implementing measures that focus on preventing flexion contracture of the hip and maintaining proper positioning. Which of the following measures will best achieve these goals? a. Encourage the patient to turn from side to side and to assume a prone position b. Initiating ROM exercises of the hip and knee 10 to 12 weeks after the amputation c. Minimizing movement of the flexor muscles of the hip d. Encouraging the patient to sit in a chair for at least eight hours a day

a

A client is to have a total hip replacement. The pre-operative plan should include which of the following? Select all that apply a. Administer antibiotics as prescribed to ensure therapeutic blood levels b. Apply leg compression device c. Request a trapeze to be added to the bed d. Teach isometric exercises of quadriceps and gluteal muscles e. Demonstrate crutch walking with the three-point gait f. Please bucks traction on the bed

a,c,d

Which information should the nurse include when performing discharge teaching with a client who had an anterior lateral approach for a total hip replacement? Select all that apply a. Avoid turning the toes or knee outward b. Use an abduction pillow between the legs when in bed c. Use an elevated toilet seat and shower chair d. Do not extend the operative leg backwards e. Restrict motion for two weeks after surgery

a,c,d

An elite high school football player has been diagnosed with a shoulder dislocation. The patient has been treated and is eager to resume his role on his team, stating that he is not experiencing pain. What should the nurse emphasize during health education? a. the need to take analgesia regardless of the short term absence of pain b. the importance of adhering to the prescribed treatment and rehabilitation regimen c. The fact that he has a permanently increased risk of future should dislocations d. The importance of monitoring for intracapsular bleeding once he resumes playing

b

A client is in balanced suspension traction using a half-ring Thomas splint with a Pearson attachment that suspends the lower extremity and applies direct skeletal traction for a hip fracture. Which of the following nursing assessments would not be appropriate? 1. Greater trochanter skin checks. 2. Pin site inspection. 3. Neurovascular checks proximal to the splint. 4. Foot movement evaluation.

c

The client is to be discharged on a low-fat, low cholesterol, low sodium diet. Which of the following should be the nurses first step in planning the dietary instructions? a. Determining the clients knowledge level about cholesterol b. Asking the client to name foods that are high in fat, cholesterol, and salt c. Explaining the importance of complying with the diet d. Assessing the clients and families typical food preferences

d

The client who has had a total hip replacement has a dislocated hip prosthesis. The nurse should first a. stabilize the leg with Buck's traction b. apply an ice pack to the affected hip c. position the client toward the opposite side of the hip d. notify the orthopedic surgeon

d

The client with an above the knee amputation is to use crutches while his prosthesis is being adjusted. In which of the following exercises should the nurse instruct the client to best prepare him for using crutches? a. Abdominal exercises b. Isometric shoulder exercises c. Quadriceps setting exercises d. Triceps stretching exercises

d

The client with peripheral arterial disease says, "I've really tried to manage my condition well." Which of the following should the nurse determine as appropriate for this client? a. Resting with the legs elevated above the level of the heart b. Walking slowly but steadily for 30 minutes twice a day c. Minimizing activity as much as often as possible d. Wearing antiembolism stockings at all times went out of bed

b

A school nurse is assessing a student who was kicked in the shin during a soccer game. The area of the injury has become swollen and discolored. The triage nurse recognizes that the patient has likely sustained what? a. Sprain b. Strain c. Contusion d. Dislocation

c

Following a total joint replacement, which of the following complications has the greatest likelihood of occurring? 1. Deep vein thrombosis (DVT). 2. Polyuria. 3. Intussception of the bowel. 4. Wound evisceration.

a

Which of the following should lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus? a. Acute respiratory distress syndrome b. Migraine like headaches c. Numbness in the right leg d. Muscle spasms in the right thigh

a

A nurse is planning the care of an older adult patient who will soon be discharged home after treatment for a fractured hip. In an effort to prevent future fractures, the nurse should encourage which of the following? Select all that apply a. regular bone density testing b. a high calcium diet c. use of falls prevention precautions d. use of corticosteroids as ordered e. weight-bearing exercise

a,b,c,e

A client has an interest scapular hip fracture. The nurse should conduct a focused assessment to detect a. Internal rotation b. Muscle flaccidity c. Shortening of the affected leg d. Absence of pain in the fracture area

c

The nurse is developing a plan of care for an older adult client with a hip fracture. Which of the following chronic health problems with the nurse be least likely to assess in the client a. Hypertension b. Cardiac decompensation c. Pulmonary disease d. Multiple sclerosis

d

Which of the following should the nurse include in the teaching plan for a client with arterial insufficiency to the feet that is being managed conservatively? a. Daily lubrication of the foot b. Soaking feet in warm water c. Applying antiembolism stockings d. Wearing firm, supportive leather shoes

a

A nurse is planning the care of a patient with osteomyelitis that resulted from a diabetic foot ulcer. the patient requires a trans metatarsal amputation. When planning the patient's post operative care, which of the following nursing diagnoses should the nurse most likely include in the plan of care? a. ineffective thermoregulation b. risk prone health behavior c. disturbed body image d. deficient diversion activity

c

Prior to surgery, the nurse is instructing a client who will have a total hip replacement tomorrow. Which of the following information is most important to include in the teaching plan at this time a. Teaching how to prevent hip flexion b. Demonstrating coughing and deep breathing techniques c. Showing the client what an actual hip prosthesis looks like d. Assessing the clients fears about the procedure

d

A nurse is writing a care plan for a patient admitted to the emergency department with an open fracture. The nurse will assign priority to what nursing diagnosis for a patient with an open fracture of the radius? a. Risk for infection b. Risk for an effective role performance c. Risk for perioperative positioning injury d. Risk for powerlessness

a

The client asked the nurse what his activity limitations are while he is in buck's traction. The nurse should tell the client a. You can sit up whenever you want b. You must lie flat on your back most of the time c. You can turn your body d. You must lie on your stomach

a

A client who had a total hip replacement four days ago was worried about dislocation of the prosthesis. The nurse should respond by saying which of the following a. Don't worry. Your new hip is very strong b. Use of a cushioned toilet seat helps to prevent dislocations. c. Activities that tend to cause abduction of the hip tend to cause dislocation, so try to avoid them d. Decreasing use of the abductor pillow will strengthen the muscles to prevent dislocation

c

A client with an extra capsular hip fracture returns to the nursing unit after an internal fixation and pin inserted with a drainage tube at the incision site. Her husband asked, "why does she have this tube inserted in her hip?" Which of the following responses would be best? a. The tube helps us to detect a wound infection early on b. This way we won't have to irrigate the wound c. Fluid won't be allowed to accumulate at the site d. We have a way to administer antibiotics into the wound

c

A young patient is being treated for a femoral fracture suffered in a snowboarding accident. The nurses most recent assessment reveals that the patient is uncharacteristically confused. What diagnostic test should be performed on this patient? a. electrolyte assessment b. electrocardiogram c. arterial blood gases d. abdominal ultrasound

c

After teaching the client with a femoral fracture about the purpose of treatment with skeletal traction, which of the following, if stated by the client, would indicate the need for additional teaching? a. To align injured bones b. To provide long-term pull c. To apply 25 pounds of traction d. To pull weight with a boot

d

And emergency department nurse is assessing a 17-year-old soccer player who presented with a knee injury. The patient's description of the injury indicates that his knee was struck immediately while his foot was on the ground. The nurse knows that the patient likely has experienced what injury? a. Lateral collateral ligament injury b. Medial collateral ligament injury c. Anterior cruciate ligament injury d. Posterior cruciate ligament injury

a

The client has a nursing diagnosis of self-care deficit related to the confinement of traction. Which of the following would indicate a successful outcome for this diagnosis? a. The client assist as much as possible in his care, demonstrating increased participation over time b. The client allows the nurse to complete his care in efficient manner without interfering c. The client allows his wife to assume total responsibility for his care d. The client allows his wife to complete his care to promote feelings of usefulness

a

The patient scheduled for a Syme amputation is concerned about the ability to eventually stand on the amputated extremity. How should the nurse best respond to the patient's concern? a. You will eventually be able to withstand full weight-bearing after the amputation b. You will have minimal weight-bearing on this extremity but you will be taught how to use an assistive device c. You likely will not be able to use this extremity but you will receive teaching on use of a wheelchair d. You will be fitted for a prosthesis which may or may not allow you to walk

a

The nurse is assessing a client who had a left hip replacement 36 hours ago. Which of the following indicates the prosthesis is dislocated? Select all that apply a. the client reported a "popping" sensation in the hip b. the left leg is shorter than the right leg c. the client has sharp pain in the groin d. the client cannot move his right leg e. the client cannot wiggle the toes on the left leg

a,b,c

The nurse is preparing the discharge of a client who has had a knee replacement with a metal joint. The nurse should instruct the client about which of the following? Select all that apply a. Notify healthcare providers about the joint prior to invasive procedures b. Avoid use of MRI c. Notify airport security that the joint may set off alarms on metal detection d. Refrain from carrying items weighing more than 5 pounds e. Limit fluid intake to 1000 mL per day

a,b,c

The nurse is teaching the client to administer Lovenox following a total hip arthroplasty. The nurse should instruct the client about which of the following? Select all that apply a. Report promptly any difficulty breathing, rash, or itching b. Notify the healthcare provider of unusual bruising c. Avoid all aspirin containing medications d. Wear or carry medical identification e. Expel the air bubble from the syringe before the injection f. Remove needle immediately after medication is injected,

a,b,c,d

When preparing a client for discharge from the hospital after a total knee replacement, the nurse should include which of the following information in the discharge plan? Select all that apply a. report signs of infection to health care provider b. Keep the affected leg and foot on the floor when sitting in a chair c. remove the anti-embolism stockings when sleeping d. the physical therapist will encourage progressive ambulation with use of assistive devices e. change the dressing daily

a,d

The client asked the nurse, "why can't the position tell me exactly how much of my leg he's going to takeoff? Don't you think I should know that?" On which of the following should the nurse base the response? a. The need to remove as much of the leg as possible b. The adequacy of the blood supply to the tissues c. The ease with which a prosthesis can be fitted d. The clients ability to walk with a prosthesis

b

A client had a posterolateral total hip replacement two days ago. What should the nurse include in the clients plan of care? Select all that apply a. When using a walker, encourage the client to point the toes inward b. Position a pillow between the legs to maintain abduction c. Allow the client to be in the supine position or in the lateral position on the unoperated side d. Do not allow the client to bend down to tie or slip on shoes e. Place ice on the incision after physical therapy

b,c,d,e

A 20 year old is brought in by ambulance to the emergency department after being involved in a motorcycle accident. the patient has an open fracture of his tibia. The wound is highly contaminated and there is extensive soft tissue damage. how would this patient's fracture likely be graded? a. Grade 1 b. Grade 2 c. Grade 3 d. Grade 4

c

A client has a leg immobilized in traction. Which of the following activities demonstrated by the client indicated that the client understands the actions to take to prevent muscle atrophy? a. The client adducts the affected leg every two hours b. The client rolls the affected leg away from the bodies midline twice per day c. The client performs isometric exercises to the affected extremity three times per day d. The client asked the nurse to add a 5 pound weight to the traction for 30 minutes per day

c

A client who has been taking summer at home for a fractured arm is admitted with a blood pressure of 80/50, a pulse rate of 115, and respirations of eight breaths per minute and shallow. The nurse interprets these findings as indicating which of the following? a. Expected common adverse effects b. Hypersensitivity reaction c. Possible habituating effect d. Hemorrhage from gastrointestinal irritation

c

A client with absent peripheral pulses and pain at rest is scheduled for an arterial Doppler study of the affected extremity. When preparing the client for this test, the nurse should a. Have the client sign a consent form for the procedure b. Administer a pretest sedative as appropriate c. keep the client tobacco free for 30 minutes before the test d. Wrap the client's affected foot with a blanket

c

A nurse is performing a shift assessment on an elderly patient who is recovering after surgery for a hip fracture. The nurse notes that the patient is complaining of chest pain, has an increased heart rate, and increased respiratory rate. the nurse further notes that the patient is febrile and hypoxic, coughing and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this patient is likely demonstrating symptoms of what complication? a. Avascular necrosis of bone b. Compartment syndrome c. Fat embolism syndrome d. Complex regional pain syndrome

c

A patient is being treated for a fractured hip and the nurse is aware of the need to implement interventions to prevent muscle wasting and other complications of immobility. What intervention best addresses the patient's need for exercise? a. performing gentle leg lifts with both legs b. performing massage to stimulate circulation c. encouraging frequent use of the overbid trapeze d. encouraging the patient to log roll side to side once per hour

c

A patient presented to the emergency department with an injury to the wrist. The patient is diagnosed with a third degree strain. Why would the physician order an x-ray of the wrist? a. nerve damage is associated with third degree strains b. compartment syndrome is associated with third degree strains c. avulsion fractures are associated with third degree strains d. greenstick fractures are associated with third degree strains

c

After surgery and insertion of a total joint prosthesis, a client develop severe sudden pain in an inability to move the extremity. The nurse correctly interpret these findings as indicating which of the following a. A developing infection b. Bleeding in the operative site c. Joint dislocation d. Glue seepage into soft tissue

c

Six weeks after an above the knee amputation (AKA), a patient returns to the outpatient office for a routine postoperative check up. During the nurses assessment the patient reports symptoms of phantom pain. What should the nurse tell the patient to do to reduce the discomfort of the phantom pain? a. Apply intermittent hot compresses to the area of the amputation b. Avoid activity until the pain subsides c. Take opioid analgesics as ordered d. Elevate the level of the amputation site

c

The client with a fractured tibia has been taking Robaxin. Which of the following indicate that the drug is having the intended affect? a. Lack of infection b. Reduction in itching c. Relief of muscle spasms d. Decrease in nervousness

c

The nurse advise the client who has had a femoral head prosthesis placement on the type of chair to sit in during the first 6 to 8 weeks after surgery. Which would be the correct type to recommend a. A desk type swivel chair b. A padded upholstered chair c. A high-back chair with armrests d. A recliner with an attached foot rest

c

the nurse has established a goal with a client to improve mobility following hip replacement. Which of the following is a realistic outcome at the time of discharge from the surgical unit a. the client can walk throughout the entire hospital with a walker b. The client can walk the length of a hospital hallway with minimal pain c. the client has increased independence in transfers from bed to chair d. The client can raise the affected leg 6 inches with assistance

c

A patient is admitted to the orthopedic unity with a fractured femur after a motorcycle accident. The patient has been placed in traction until his femur can be rodded in surgery. For what early complications should the nurse monitor this patient? Select all that apply a. Systemic infection b. complex regional pain syndrome c. DVT d. compartment syndrome e. fat embolism

c,d,e

A client with a double hip spica cast is constipated. The surgeon cuts a window into the cast. Which of the following outcomes should the nurse anticipate? a. The window will allow the nurse to palpate the superior mesenteric artery b. The window will allow the surgeon to manipulate the fracture site c. The window will allow the nurses to reposition the cast d. The window will provide some relief from pressure due to abdominal distention as a result of constipation

d

A client with a fractured has not had any immunizations since childhood. Which of the following biologic products should the nurse administer to provide the client with passive immunity for tetanus? a. Tetanus toxoid b. Tetanus antigen c. Tetanus vaccine d. Tetanus antitoxin

d

A nurse is preparing to discharge an emergency department patient who has been fitted with a sling to support her right arm after a clavicle fracture. What should the nurse instruct the patient to do? a. Elevate the arm above the shoulder 3 to 4 times daily b. Avoid moving the elbow, wrist, and fingers until the bone remodeling is complete c. Engage in active range of motion using the affected arm d. Use the arm for light activities within the range of motion

d

A patient is brought to the emergency department by ambulance after stepping in a hole and falling. While assessing him, the nurse notes that his right leg is shorter than his left leg; his right hip is noticeably deformed and he is in acute pain. Imaging does not reveal a fracture. which of the following is the most plausible explanation for this patient's signs and symptoms? a. sublimated right hip b. right hip contusion c. hip strain d. traumatic hip dislocation

d

A patient who has had an amputation is being cared for by a multidisciplinary rehabilitation team. What is the primary goal of this multidisciplinary team? a. maximize the efficiency of care b. ensure the patient's health care is holistic c. Facilitate the patient's adjustment to a new body image d. promote the patient's highest possible level of function

d

After knee arthroplasty, the client has a sequential compression device. The nurse should do which of the following a. Elevate the sequential compression device on two pillows b. Change the settings on the SCD to make the client more comfortable c. Stop the SCD and remove dressings and bathe the leg d. Discontinue the SCD when the client is ambulatory

d

Following a total hip replacement, the nurse should position the client in which of the following ways a. Play suites alongside the effect it is dramedy to keep the extremity from rotating b. Elevate both feet on two pillows c. Keep the lower extremities adopted by use of an Emma will ovation binder around both legs. Keep the extremity and slight abduction using an abduction splint or pillows placed between the thighs

d

A nurse is preparing to discharge a patient from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage which of the following? a. Apply heat for the first 24 to 48 hours after the injury b. Maintain the ankle in a dependent position c. Exercise hourly by performing rotation exercises of the ankle d. Keep an elastic compression bandage on the ankle

d

A client says, "I hate the idea of being an invalid after they cut off my leg." Which of the following would be the nurse's most therapeutic response? a. At least you will still have one good like to use b. Tell me more about how you're feeling c. Let's finish the preoperative teaching d. You're lucky to have a wife to care for you

b

A patient has sustained a long bone fracture and the nurse is preparing the patient's care plan. Which of the following should the nurse include in the care plan? a. Administer vitamin D and calcium supplements as ordered b. Monitor temperature in pulses of the affected extremity c. Performed passive range of motion exercises as tolerated d. Administer corticosteroids as ordered

b

A patient with a simple arm fracture is receiving discharge education from the nurse. What would the nurse instruct the patient to do? a. Elevate the affected extremity to shoulder level when at rest b. Engage in exercises that strengthen the unaffected muscles c. Apply topical anesthetics to accessible skin services as needed d. Avoid using analgesic so that further damage is not masked

b

The nurse is assessing the home environment of an elderly client who is using crutches during a postoperative recovery phase after hip pinning. Which of the following would pose the greatest hazard to the client as a risk for falling at home? a. A four-year-old cocker spaniel b. Scatter rugs c. Snack tables d. Rocking chairs

b

When admitting a client with a fractured extremity, the nurse should first focus on the assessment on which of the following? a. The area proximal to the fracture b. The actual fracture site c. The area distal to the fracture d. The opposite extremity for baseline comparison

c

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

a

A patient was fitted with an arm cast after fracturing her humerus. Twelve hours after the application of the cast, the patient tells the nurse that her arm hurts. Analgesics do not relieve the pain. What would be the most appropriate nursing action? A) Prepare the patient for opening or bivalving of the cast. B) Obtain an order for a different analgesic. C) Encourage the patient to wiggle and move the fingers. D) Petal the edges of the patient's cast.

a

A patient who had a below the knee amputation is to be fitted with a temporary prosthesis. It is important for the nurse to teach the patient to do what? a. Inspect the residual limb daily for irritation b. Apply and elastic shrinker before applying the prosthesis c. Perform range of motion exercises to the affected leg four times a day d. Apply alcohol to the residual limb every morning and evening too toughen the skin

a

A patient who has undergone a lower limb amputation is preparing to be discharged home. What outcome is necessary prior to discharge? a. Patient can demonstrate safe use of assistive devices b. Patient has a healed, nontender, non-adherent scar c. Patient can perform activities of daily living independently d. Patient is free of pain

a

A patient with a fractured femur experiences the complication of malunion. The nurse recognizes that what happens with this complication? a. The fracture heals in an unsatisfactory position b. The fracture fails to heal properly despite treatment c. Fracture healing progresses more slowly than expected d. Loss of bone substances occurs as a result of immobilization

a

And immediate prosthetic fitting during surgery is used for a patient with a traumatic below the knee amputation. During the immediate postoperative period, what is priority nursing intervention? a. Monitor the patient's vital signs b. Assess the incision for hemorrhage c. Elevate the residual limb on pillows d. Have the patient flex and extend the knee every hour

a

The patient had a fracture. At 3 weeks to 6 months there is clinical union, and this is the first stage of healing that is sufficient to prevent movement of the fracture site when the bones are gently stressed. How is this stage of fracture healing documented? a. Ossification b. Remodeling c. Consolidation d. Callus formation

a

Why does a nurse position a patient with an above the knee amputation with a delayed prosthetic fitting prone several times a day? a. To prevent flexion contractures b. To assess the posterior skin flap c. To reduce edema in the residual limb d. To relieve pressure on the incision site

a

a 25 year old man is involved in a motorcycle accident and injures his arm. The physician diagnoses the man with an introduction-articular fracture and splints the injury. The nurse implements the teaching plan developed for this patient. What sequela of intra-articular fractures should the nurse describe regarding the patient? a. Post-traumatic arthritis b. fat embolism syndrome c. osteomyelitis d. compartment syndrome

a

When developing a teaching plan for a client who is prescribed Tylenol for muscle pain, which information should the nurse expect to include? Select all that apply a. The drug can be used if the person is allergic to aspirin b. Acetaminophen does not affect platelet aggregation c. This drug causes little or no gastric distress d. Acetaminophen exerts a strong anti-inflammatory effect e. The client should have the INR checked regularly

a,b,c

An older adult patient experienced a fall and required treatment for a fractured hip on the orthopedic unit. Which of the following are contributory factors to the incidence of falls and fractured hips among the older adult population? Select all that apply a. Loss of visual acuity b. Adverse medication effects c. Slow reflexes d. Hearing loss e. Muscle weakness

a,b,c,e

The x-ray shows that the patient's fracture is at the remodeling stage. What characteristics of the fracture healing process are happening at the stage? Select all that apply a. Radiologic union b. Absorption of excess cells c. Return to pre-injury strength and shape d. Semi solid blood clot at the ends of fragments e. Deposition and absorption of bone in response to stress f. An organized network of bone woven around fracture parts

a,b,c,e

What should be included in the management during the first 48 hours after an acute soft tissue injury of the ankle? Select all that apply a. Use of elastic wrap b. Initial immobilization and rest c. Elevation of ankle above the heart d. Alternating the use of heat and cold e. Administration of anti-inflammatory drugs

a,b,c,e

What emergency considerations must be included with facial fractures? Select all that apply a. Airway patency b. Oral examination c. Cervical spine injury d. Cranial nerve assessment e. Immobilization of the jaw

a,c

A nurse is caring for a patient who has suffered an unstable thoracolumbar fracture. Which of the following is the priority during nursing care? a. Preventing infection b. Maintaining spinal alignment c. Maximizing function d. Preventing increased intracranial pressure

b

A nurses assessment of a patient's knee reveals edema, tenderness, muscle spasms, and ecchymosis. The patient states that two days ago he ran 10 miles and now it really hurts to stand up. The nurse should plan care based on the belief that this patient has experienced what? a. First-degree strain b. Second-degree strain c. First degree sprain d. Second-degree sprain

b

A patient complains of pain in the foot 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 prosthesis d. It can be managed with a diversion because it is psychologic

b

A patient is admitted with an open fracture of the tibia following a bicycle accident. During assessment of the patient, what specifically should the nurse question the patient about? 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

A patient is discharged from the outpatient clinic following application of synthetic fiber glass long arm cast for a fractured all night. Before discharge, the nurse instruct the patient to do what? a. Never get the cast wet b. Move the shoulder and fingers frequently c. Placed tape petals around the edges of the cast when it is dry d. Use this link to support the arm at waist level for the first 48 hours

b

The client who has had an open femoral fracture was discharged to her home where she developed fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg. Which of the following reflects the best interpretation of these findings? a. Pulmonary emboli b. Osteomyelitis c. Fat emboli d. Urinary tract infection

b

The nurse is providing care for a patient who has had a below the knee amputation. The nurse enters the patient's room and finds him resting in bed with his residual limb supported on pillow. What is the nurse's most appropriate action? a. Inform the surgeon of this finding b. explain the risks of flection contracture to the patient c. transfer the patient to a sitting position d. encourage the patient to perform active ROM exercises with the residual limb

b

Following a total hip replacement, the nurse should do which of the following? Select all that apply a. With the aid of a coworker, turn the client from the supine to the prone position every two hours b. Encourage the client to use the overload trapeze to assist with position changes c. For meals, elevate the head of the bed to 90° d. Use a fracture bedpan when needed by the client e. When the client is in bed, prevent thromboembolism bank urging the client to do toe pointing exercises

b,d,e

Which joint surgery is used to arthroscopically remove degenerative tissue in joints? a. Osteotomy b. Arthrodesis c. Debridement d. Synovectomy

c

24 hours after a below the knee amputation, a patient uses the call system to tell the nurse that his dressing (a compression bandage) has fallen off. What is the first action that the nurse should take? a. Apply ice to the site b. Cover the incision with dry gauze c. Reapply the compression dressing d. Elevate the extremity on a couple of pillows

c

A patient with a fractured tibia accompanied by extensive soft tissue damage and initially has a splint Applied and held in place with an elastic bandage. What early sign should alert the nurse that the patient is developing compartment syndrome? a. Paralysis of the toes b. Absence of peripheral pulses c. Distal pain and relieved by opioid analgesics d. Skin over the injury site is blanched when the bandage is removed

c

A patient with an extracapsular hip fracture is admitted to the orthopedic unit and placed in bucks traction. The nurse explains to the patient that the purpose of the traction is to do what? a. Pull bone fragments back into alignment b. Immobilize the leg until healing is complete c. Reduce pain and muscle spasms before surgery d. Prevent damage to the blood vessels at the fracture site

c

The athlete comes to the clinic with bursitis. What does the nurse know happens to the tissue to cause pain when bursitis occurs? a. Tearing a ligament b. Stretching of muscle and fascia sheath c. Inflammation of synovial membrane sac at friction sites d. Incomplete separation of articular surfaces of joint caused by ligament injury

c

The nurse suspects a fat embolism rather than a pulmonary embolism from a venous thrombosis when the patient with a fracture develops what? a. Tachycardia and dyspnea b. A sudden onset of chest pain c. Petechiae around the neck and upper chest d. ECG changes and decreased PaO2

c

The nurse teaches individuals that one of the best ways to prevent musculoskeletal injuries during physical exercise is by doing what? a. Increase muscle strength with daily isometric exercise b. Avoid exercising on concrete or hard pavement surfaces c. Perform stretching and warm-up exercises before exercise d. wrap susceptible joints with elastic bandages or adhesive tape before exercise

c

The patient 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

The woman with osteoporosis slipped on the ice and now her wrist hurts. If there is a fracture, what type of fracture is expected? a. Dislocation b. Open fracture c. Colles' fracture d. Incomplete fracture

c

When preparing a patient for discharge following fixation of a mandibular fracture, the nurse determines that teaching has been successful when the patient says what? a. I can keep my mouth moist by sucking on hard Candy b. I should cut the wires with scissors if I begin to vomit c. I may use bulk forming laxative if my liquid diet causes constipation d. I should use a moist swab to clean my mouth every time I eat something

c

When the nursing student asks the RN what an arthroplasty is, what is the best description the RN can give the student? a. Surgical fusion of a joint to relieve pain b. Correction of bone deformity by removal of a wedge or slice of bone c. Reconstruction or replacement of a joint to relieve pain and correct deformity d. Used in rheumatoid arthritis to remove the tissue involved in joint destruction

c

Which of the following client statements identifies a knowledge deficit about cast care? a. I'll elevate the cast above my heart initially b. I'll exercise my joints above and below the cast c. I can pull out cast padding to scratch inside the cast d. I'll apply ice for 10 minutes to control edema for the first 24 hours

c

Which of the following should the nurse identify as the least likely factor contributing to a client's peripheral vascular disease? a. Uncontrolled diabetes mellitus for 15 years b. a 20-pack-per-year of cigarette smoking c. current age of 39 years d. a serum cholesterols concentration of 275 mg/dL

c

Which type of fracture occurred when there is radial nerve and brachial artery damage in the fracture is reduced with a hanging arm cast? a. Fractured tibia b. Colles fracture c. Fractured humerus d. femoral shaft fracture

c

A 65-year-old patient has undergone a right total hip arthroplasty with a cemented prosthesis for treatment of severe osteoarthritis of the hip. What is included in the activity the nurse anticipates for the patient on the patient's first or second postoperative day? a. Transfer from the bed to the chair twice a day only b. Turning from the back to the unaffected side Q2h only c. Crutch walking with non-weight bearing on the operative leg d. Ambulation and weight-bearing on the right leg with a walker

d

A 72-year-old man tells the nurse that he cannot perform most of the physical activities he could do five years ago because of overall joint aches and pains. What can the nurse do to assist a patient to prevent further deconditioning and decrease the risk of developing musculoskeletal problems? a. Limit weight-bearing exercise to prevent stress on fragile bones and possible hip fractures b. Advise the patient to avoid the use of canes and walkers because they increase dependence on ambulation aids c. Advise the patient to increase his activity by more frequently climbing stairs in buildings and other environments with steps d. Discuss use of over-the-counter medications to decrease inflammation and pain so the exercise can be

d

A patient 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 healthcare provider d. Neurovascular checks before the site of the injury

d

A patient with a fractured right hip has an interior open reduction and internal fixation of the fracture. What should the nurse plan to do postoperatively? a. Get the patient up to the chair on the first postoperative day b. Position the patient only on the back and the uncooperative side c. Keep the leg abductor pillow on the patient even when bathing d. Have a family member put on the patient's shoes and socks

d

A young patient with a fractured femur has a hip spica cast applied. While the cast is drying, what should the nurse do? a. Elevate the legs above the level of the heart for 24 hours b. Turn the patient to both sides and prone to supine every two hours c. Cover the cast with a light blanket to avoid chilling from evaporation d. Assess the patient frequently for abdominal pain, nausea, and vomiting

d

An older adult woman is admitted to the emergency room after falling at home. The nurse cautions her to not put weight on her leg after finding what in the patient assessment? a. Inability to move the toes and ankle b. Edema of the thigh extending to the knee c. Internal rotation of the leg with groin pain d. Shortening and external rotation of the leg

d

Following change of shift handoff, which patient should the nurse assess first? a. A 58-year-old male experiencing phantom pain and requesting analgesics b. A 72-year-old male being transferred to a skilled nursing unit following repair of a hip fracture c. A 25-year-old female in left leg skeletal traction asking for the weights to be lifted for a few minutes d. A 68-year-old male with a new lower leg cast complaining that the cast is too tight and he cannot feel his toes

d

The nurse teaches a client about using the crutches instructing the client to support her weight primarily on which of the following body areas? a. Axillae b. Elbows c. Upper arms d. Hands

d

The patient works on a computer eight hours each day. What kind of repetitive strain injury would be expected in this patient? a. Meniscus injury b. Rotator cuff injury c. Radial ulnar fracture d. Carpal tunnel syndrome

d

A client has had an above the knee amputation and develops a dime size bright red spot on the dressing after 45 minutes in the post anesthesia recovery unit. The nurse should a. Elevate the stump b. Reinforce the dressing c. Call the surgeon d. Draw and mark around the site

d

The nurse is assessing a client's left leg for neuromuscular changes following a total knee replacement. Which of the following are expected normal findings? Select all that apply a. reduced edema of the left knoww b. skin warm to touch c. capillary refill response d. moves toes e. pain absent f. pulse on left eg weaker than right leg

a,b,c,d

When teaching a client with an extra capsular hip fracture scheduled for a surgical internal fixation with the insertion of a pin, the nurse bases the teaching on the understanding that the surgical repair is the treatment of choice. Which of the following explains the reason? a. Hemorrhage at the fracture site is prevented b. Neurovascular impairment risk is decreased c. The risk of infection at the site is lessened d. The client is able to be mobilized sooner

d

the surgical nurse is admitting a patient from post anesthetic recovery following the patient's below the knee amputation. The nurse recognizes the patient's high risk of postoperative hemorrhage and should keep which of the following at the bedside? a. a tourniquet b. a syringe preloaded with vitamin k c. a unit of packed red blood cells, placed on ice d. a does of protamine sulfate

a

a patient has returned to the post surgical unit from the PACU after an above the knee amputation of the right leg. Results of the nurse's initial post surgical assessment were unremarkable but the patient has called out. The nurse enters the room and observes copious quantities of blood at the surgical site. What should the nurse's initial action be? a. apply a tourniquet b. Elevate the residual limb c. Apply sterile gauze d. Call the surgeon\

a

a rehabilitation nurse is working with a patient who has had a below the knee amputation. The nurse knows the importance of the patient's active participation in self care. in order to determine the patient's ability to be an active participant in self care, the nurse should prioritize assessment of what variable? a. The patient's attitude b. the patient's learning style c. The patient's nutritional status d. The patient's presurgical level of function

a

What is a disadvantage of open reduction and internal fixation of a fracture compared to closed reduction? a. Infection b. Skin irritation c. Nerve impairment d. Complications of immobility

a

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

a

Which kind of hip fracture is usually repaired with a hip prosthesis? a. Intracapsular b. Extracapsular c. Subtrochanteric d. Intertrochanteric

a

A patient with severe ulnar deviation of the hands undergoes and arthroplasty with reconstruction and replacement of finger joints. Postoperatively, what is the most important for the nurse to do? a. Position the fingers lower than the elbow b. Perform neurovascular assessment of the fingers Q2 to 4 hours c. Encourage the patient to gently flex, extend, abduct, and adduct the fingers Q4 hours d. Remind the patient that function of the hands is more important than their cosmetic appearance.

b

Application of RICE (rest, ice, compression, and elevation) is indicated for initial management of which type of injury? a. Muscle spasms b. Sprains and strains c. Repetitive strain injury d. Dislocations and subluxations

b

Following a knee arthroplasty, a patient has a continuous passive motion machine for the affected joint. The nurse explains to the patient that this device is used for what purpose? a. To relieve edema and pain at the incision site b. To promote early joint mobility and increase knee flexion c. To prevent venous stasis and the formation of a deep venous thrombosis d. To improve arterial circulation to the affected extremity to promote healing

b

In a patient with a stable vertebral fracture, what should the nurse teach the patient to do? a. Remain on bedrest until the pain is gone b. Logroll to keep the spine straight when turning c. How do use bone cement to correct the problem d. Take as much analgesic as needed to relieve the pain

b

The patient asks, "what does the doctor mean when he says that I have an avulsion fracture in my leg?" I thought I had a sprain!" What is the best response by the nurse? a. It is a fracture with more than two fragments b. It means that a ligament pulled a bone fragment loose c. The line of the fracture is twisted along the shaft of the bone d. The line of the fracture is at right angles to the longitudinal axis of the bone

b

The patient is brought to the emergency department with an injured lower 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

To assess for neurologic status in a patient with a fractured humorous, what should the nurse asked the patient to do? a. evert, invert, dorsiflex, and plantar flex the foot b. Abduct, adduct, and oppose the fingers and pronate and supinate the hand c. Assess the location, quality, and intensity of pain below the site of the injury d. Assess the color, temperature, capillary refill, peripheral pulses, and presence of edema in the extremity

b

When positioning the patient after a total hip arthroplasty with a posterior approach, it is important that the nurse maintain the affected extremity in what position? a. Adduction and flexion b. Abduction and extension c. Abduction and internal rotation d. Abduction and external rotation

b

nurse in a busy emergency department provides care for many patients who present with contusions, strains, or sprains. Treatment modalities that are common to all of these musculoskeletal injuries include which of the following? Select all that apply a. Massage b. Applying ice c. Compression dressings d. Resting the affected extremity e. Corticosteroids f. Elevating the injured limb

b,c,d,f

In preparation for total knee surgery, a 200 lb client with osteoarthritis must lose weight. Which of the following exercises should the nurse recommend as best if the client has no contraindications? a. weight lifting b. walking c. aquatic exercise d. tai chi exercise

c

On the evening of surgery for total knee replacement, a client wants to get out of bed. to safely assist the client the nurse should do which of the following? a. encourage the client to apply full weight bearing b. order a walker for the client c. place a straight backed chair at the foot of the bed d. apply a knee immobilizer

d

The nurse is planning care for a group of clients who have had total hip replacement. Of the clients listed below, which is the highest risk for infection and should be assessed first? a. a 55 year old client who is 6 feet tall and weighs 180 lb b. a 90 year old who lives alone c. a 74 year old who had periodontal disease with periodonitis d. a 75 year old who has had asthma and uses an inhaler

c

The patient has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing his ankle. diagnostic imaging reveals that bone union is not taking place. What factor may have contributed to this complication? a. Inadequate vitamin d intake b. bleeding at the injury site c. inadequate immobilization d. VTE

c

an emergency department patient is diagnosed with a hip dislocation. The patient's family is relieved that the patient has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement? a. the longer the joint is displaced, the more difficult it is to get it back in place. b. The patient's pain will increase until the joint is realigned c. dislocation can become permanent if the process of bone remodeling begins d. avascular necrosis may develop at the site of the dislocation if it is not promptly resolved

d

The nurse is planning care for the client with a femoral fracture who is in balanced suspension traction. Which of the following with the nurse be least likely to include in the plan of care? a. Use of a fracture bedpan b. Checks for redness over the ischial tuberosity c. Elevation of the head of the bed no more than 25° d. Personal hygiene with a complete bed bath

d

A client has a tibial fracture that required casting. Approximately 5 hours later, the client has increasing pain distal to the left tibial fracture despite the morphine injection administered 30 minutes previously. Which of the following should be the nurse's next assessment? 1. Presence of a distal pulse. 2. Pain with a pain rating scale. 3. Vital sign changes. 4. Potential for drug tolerance.

a

A client returned from surgery with a debrided open tibial fracture and has a three-way drainage system. The nurse should first a. Review the results of culture and sensitivity testing of the wound b. Look for the presence of a pressure dressing over the wound c. Determine if the client has increased pain from exposed nerve endings d. Check the patient's blood pressure for hypotension resulting from additional vessel bleeding

a

A client who had a total hip replacement two days ago has developed an infection with a fever. The nursing diagnosis of fluid volume deficit related to diaphoresis is made. Which of the following is the most appropriate outcome a. The client drinks 2000 mL of fluid per day b. The client understands how to manage the incision c. The clients bed linens are changed as needed d. The client skin remains cool throughout hospitalization

a