Med-Surg Ch 32: Care of Patients With Musculoskeletal and Connective Tissue Disorders

Reduction of fracture through surgical incision

Open reduction

The patient has suffered a fracture of the humerus in an accident and has a new cast. Compartment syndrome is a potential complication. A typical sign or symptom would be A. rash on the distal extremity B. swelling of the fingers C. pain unrelieved by analgesia D. fever and restlessness

pain unrelieved by analgesia

Disease-modifying antirheumatic drugs prevent joint and cartilage destruction by A. suppressing the immune system B. stimulating cortisol production C. providing collagen to the joints D. blocking pain transmission

suppressing the immune system

A 24-year-old woman limps into the emergency department after twisting her ankle during a soccer game. On examination, there is local swelling and difficulty maintaining balance. What immediate therapeutic measure(s) should your provide? (select all that apply) A. Application of elastic bandage B. Application of an ice pack C. Elevation of the ankle D. Ankle rest and limited weight bearing E. Application of a topical anesthetic

1. Application of elastic bandage 2. Application of an ice pack 3. Elevation of the ankle *Elevation, application of ice, and then wrapping with an elastic bandage are immediate measures used in the emergency department for a sprained ankle. (4) Ankle rest and limited weight bearing should occur after leaving the emergency department. (5) A topical anesthetic is not used for an ankle sprain.

The patient presents to the clinic with a compound fracture of the right leg. The nurse anticipates the administration of which classes of medications? (Select all that apply.) A. Hepatitis B vaccine B. Aspirin C. Corticosteroids D. Tetanus booster E. IV antibiotics

1. Corticosteroids 2. Tetanus booster 3. IV antibiotics *The nurse should anticipate administering a tetanus immunization or booster and IV prophylactic antibiotics to prevent infection in the patient who has suffered an open fracture. The patient has an open wound, so aspirin is not appropriate due to the risk of bleeding. The hepatitis B vaccine and corticosteroids are not necessary for this patient.

The nurse is educating a patient going home with a short arm synthetic cast. Which instructions should the nurse include in the teaching plan? (select all that apply) A. Cover the cast with a plastic bag when taking a shower B. Blow warm air into the cast to relieve itching C. Observe skin at the edge of the cast for irritation or injury D. Check circulation and sensation in the fingers frequently E. Move an flex the fingers to stimulate circulation

1. Cover the cast with a plastic bag when taking a shower 2. Observe skin at the edge of the cast for irritation or injury 3. Check circulation and sensation in the fingers frequently 4. Move an flex the fingers to stimulate circulation *It itching occurs, cool air would be most helpful not warm

The patient is returning to the unit with a wet long leg cast. To prevent damage to the wet cast, what action(s) should the nurse take? (select all that apply) A. Determine the cast material B. Prop the cast limb on a footboard and elevate it until the cast is dry C. Support the cast with the palms of the hands rather than holding it with the fingers D. Assess heat generated from the drying cast E. Explain that the cast has dried when it acquires a grayish color

1. Determine the cast material 2. Support the cast with the palms of the hands rather than holding it with the fingers 3. Assess heat generated from the drying cast *Determining the cast material will inform the nurse of how quickly the cast can be expected to dry. The cast should be supported with the palms of the hands rather than holding it with the fingers. The heat of the drying cast should be evaluated to prevent skin irritation. A grayish color indicates that the cast is still wet

A patient presents to the emergency department immediately after an injury. An x-ray has been ordered for a suspected dislocation. Before confirmation by x-ray, which finding(s) support the potential diagnosis? (select all that apply) A. History of forceful injury B. Purple-black hematoma over joint C. Severe pain, aggravated by motion D. Muscle spasm E. Abnormal appearance of joint

1. History of forceful injury 2. Severe pain, aggravated by motion 3. Muscle spasm 4. Abnormal appearance of joint *A dislocation will be evidenced by severe pain aggravated by motion, muscle spasm, and an abnormal-appearing joint after the history of a forceful injury. A hematoma, it if forms, will not be evident for a few hours

The nurse suspects compartment syndrome in a patient with a side arm cast and traction when observing which finding(s) (select all that apply) A. Warm, rosy fingers B. Intense pain in hand and fingers C. Edema of fingers D. Weak radial pulse E. Tingling and numbness

1. Intense pain in hand and fingers 2. Edema of fingers 3. Weak radial pulse 4. Tingling and numbness *Compartment syndrome is a restriction of blood flow that occurs in one or more muscle compartments of the extremities. Compartment syndrome is caused by external or internal pressure. The main sign of compartment syndrome is severe, unrelenting pain that is out of proportion to the injury and unrelieved by narcotics. Decreased sensation, numbness and tingling, paleness of the skin, and weakness of the extremity are other signs. Warm, rosy fingers would be assessed as a sign of adequate perfusion

Which statement(s) accurately describe the advantage(s) of fiberglass casts? (select all that apply) A. Lighter weight B. Allowance of weight bearing after 30 minutes C. Cheaper D. Dries more quickly E. Easily pliable F. Smooth surface that is less abrasive to skin

1. Lighter weight 2. Allowance of weight bearing after 30 minutes 3. Dries more quickly *Fiberglass casts are lighter and dry quickly, allowing weight bearing in as little as 30 minutes. Fiberglass casts are very expensive and do not lend themselves to molding body parts. The surface is very rough and often abrades the skin

Bone is partially broken and partially bent

Greenstick fracture

The nurse is caring for a patient who works as a legal secretary. The patient asks the nurse about ways to avoid developing carpal tunnel syndrome (CTS). Which action should the nurse suggest? A. "Exercise your wrists with repetitive flexion movements nightly." B. "Wrap your wrists with elastic bandages." C. "Acquire a pad to support your wrists while typing." D. "Apply warm compresses to wrists every evening."

"Acquire a pad to support your wrists while typing." *Elevating the wrist with a firm support eliminates the need to keep the wrists flexed for long periods of time. This wrist support will help prevent CTS. Repetitive motion increases risk for carpal tunnel. Wrapping the wrists or applying warm compresses do not lessen risk of developing carpal tunnel

You must watch the patient with a fracture of the femur for a fat embolism. Signs and symptoms include A. Increased blood pressure, rapid pulse, and fever B. altered mental status, petechiae on chest, and dyspnea C. increased pain in the leg, foot swelling, and rapid pulse D. increased WBCs, hypotension, and difficulty breathing

altered mental status, petechiae on chest, and dyspnea

Fracture that has not broken through the skin

closed fracture

After sustaining a rotator cuff tear, a patient's arm is placed in a sling. The patient is instructed to rest and to take ibuprofen (Motrin) for pain. Which patient indicates a need for further teaching? A. "I will have less stomach upset if I take the pills with food." B. "I will not be able to play tennis for a while." C. "I need to rest in bed for the next 2 days." D. "The sling must be work most of the time."

"I need to rest in bed for the next 2 days." *The patient with a rotator cuff tear does not need bed rest. (1) Taking ibuprofen with food is advisable to prevent stomach irritation. (2) The patient will not be able to play tennis for a while. (4) The sling should be worn most of the time.

Which statement indicates that the patient needs further instruction about application of ice to a sprain? A. "I know this ice will reduce the swelling." B. "I will keep the ice on this knee for the rest of the day." C. "I will use the ice as you have directed for 24 h ." D. "I can elevate my leg and use ice to reduce swelling."

"I will keep the ice on this knee for the rest of the day." *Ice should be applied for 20 minutes of each hour for the first 2 h

When the clinic nurse starts to take the "air cast" off the grade 2 sprain, the patient asks why it is being removed since he still has pain. Which explanation is best? A. "Long-term immobilization can interfere with adequate circulation." B. "Long-term immobilization may increase long-term edema." C. "Long-term immobilization can cause permanent disability." D. "This cast will be replaced with a heavier cast."

"Long-term immobilization can cause permanent disability." *Air casts, braces, or supports are used only until a joint has been strengthened. If a joint is immobilized too long and muscles are not exercised, muscle atrophy--which begins in a matter of days--can cause permanent disability

The patient with osteoporosis calls the nurse in the doctor's office to report that she should have take but has forgotten to take her weekly bisphosphonate (alendronate {Fosamax}) that was due 2 days ago. How should the nurse advise the patient? A. "Take the dose now with 8 ounces of water." B. "Take two doses 3 days apart." C. "Skip this week and pick up the schedule next week." D. "Take two tablet now with a snack."

"Skip this week and pick up the schedule next week." *If 2 or more days have passed since the regular dose time, this week's dose should be skipped and the weekly schedule should be picked up next week

Patients with rheumatoid arthritis who are receiving Enbrel or other biological response modifiers must be watched for complications such as (select all that apply) A. hearing loss B. serious infection C. severe edema D. blood dyscrasias E. signs of demyelination F. skin eruptions

1. serious infection 2. blood dyscrasias 3. signs of demyelination

The patient presents to the clinic after falling from her bike and is diagnosed with a Grade II ankle sprain. The nurse should make which statements to the patient regarding the treatment of her sprained ankle? (Select all that apply.) A. "Place an ice pack on your ankle for 30 minutes every 4 h." B. "Take stimulant laxatives with your narcotic pain medication." C. "Begin walking on your injured ankle after 24 h, and increase your ambulation as tolerated." D. "Rest your ankle as much as possible." E. "You should wrap your ankle with an elastic bandage." F. "Prop your ankle on pillows while resting."

1. "Rest your ankle as much as possible." 2. "You should wrap your ankle with an elastic bandage." 3. "Prop your ankle on pillows while resting." *The nurse should educate the patient about the acronym RICE: rest, ice, compression, and elevation. The patient will not likely be prescribed a narcotic pain medication for a grade II sprain. In addition, increased fluids and dietary fluids would be recommended first, then a stool softener, and, lastly, a laxative. The patient should use an ice pack for 10 to 20 minutes every 1 to 2 h. The patient should not walk on the ankle until cleared by the physician.

What are the 6 P's of compartment syndrome?

1. Pain 2. Pallor 3. Paresthesia 4. Paralysis 5. Pulselessness 6. Poikilothermia

When a patient with a new hip is being prepared for discharge, you should give which instructions to avoid dislocation of the prosthesis? (select all that apply) A. sit only on low chairs B. use a raised toilet seat C. do not lie on your back in bed D. use a pillow between your knees when lying down E. do not cross your legs at the knee or ankle F. be careful not to bend at the hip more than 90 degrees

1. use a raised toilet seat 2. use a pillow between your knees when lying down 3. do not cross your legs at the knee or ankle 4. be careful not to bend at the hip more than 90 degrees

The patient in the outpatient surgery center has just returned from surgery to decompress the medial nerve as treatment for carpal tunnel syndrome. Which assessment finding immediately after surgery would alert the nurse to a possible complication? A. Nail beds that are pink B. Fingertips that are warm to the touch C. Numbness of the fingertips D. 5-second nail bed capillary refill

5-second nail bed capillary refill *The nurse should assess the perfusion of the hand. A capillary refill time of more than 2 seconds may indicate a problem and should be reported to the surgeon immediately. Right after surgery, the patient is not expected to have sensation in the fingers. Pink, warm skin is a normal finding.

A patient is in her first postoperative day after a total hip replacement as treatment for degenerative arthritis. The patient's operated limb must be kept in what position? A. Adduction B. Externally rotated C. Internally rotated D. Abduction

Abduction

When caring for a patient who has an abductor wedge in place after a total hip replacement, for which finding should the nurse assess? A. Muscle spams B. Alteration in peripheral circulation C. Compression fracture D. Appropriateness of the size of the wedge

Alteration in peripheral circulation *Pressure from the abductor wedge can interrupt arterial blood supply and compress the peroneal nerve

You have just received shift report on four assigned orthopedic patients. Which patient should you check on first? A. A young trauma patient with a below-the-knee amputation who is having phantom pain B. An older adult woman with a total hip replacement who needs assistance with the bedpan C. A woman with an external fixation device who has a fever and foul odor at the pin sites D. A man with a full leg cast who reports pain despite elevation and pain medication

An older adult woman with a total hip replacement who needs assistance with the bedpan *Assisting the hip replacement patient who needs help with the bedpan should be done first so that the patient does not have an accident with feces or urine in the bed that might contaminate her wound and dressing; a nursing assistant could be sent to attend to the patient. (1) The patient with phantom pain needs assistance but does not take priority. (3) The woman with an external fixation device who has a fever and foul odor at the pin sites is experiencing an infection, and the surgeon needs to be notified so that treatment can be started. This would be your second action. (4) The man with the full leg cast who is experiencing pain needs to be reassessed and pain relief sought.

The nurse is caring for a patient with a newly applied cast to the lower extremity. The patient continues to complain of pain despite medication and repositioning. What should the nurse do first? A. call the health care provider to obtain an order for additional medication B. use distraction techniques such as computer games or puzzle books C. Assess the temperature of the toes, sensation to touch, and capillary refill D. Tell the patient that the medication has not had enough time to work

Assess the temperature of the toes, sensation to touch, and capillary refill

The industrial nurse examines an employee who complains of right shoulder pain on abduction. He points with one finger to the exact location of the sprain and mentions that he won a racquetball tournament yesterday. The nurse suspects the employee is suffering from which problem? A. Rotator cuff tear B. Bursitis C. Dislocation D. Subluxation

Bursitis *Bursitis occurs after overuse, with pain in the joint on activity with erythema and little, if any swelling. Dislocations are very painful and the pain is spread all over the shoulder. The shoulder also looks misshapen in a dislocation. Rotator cuff teat would prevent the patient from abducting his shoulder

An 80-year-old man falls and suffers a compound fracture of the femur. Which immediate action is most appropriate? A. Position him flat on his back B. Apply a tourniquet on the leg C. Carefully splint the leg as it is D. Carefully straighten the leg

Carefully splint the leg as it is *Any fracture, even a compound one, should be immobilized in position to avoid further injury to the soft tissue attached to the bone. Any other initial action may cause further injury

The patient in a long arm cast (from below the shoulder to the wrist, with a 90 degree elbow flexion) complains of a burning sensation over the elbow. The nurse's initial intervention should be A. Elevate the casted arm on pillows B. Check to see if the cast is properly supported C. Notify the charge nurse of developing pressure ulcer D. Cut a "window" in the cast

Check to see if the cast is properly supported *The initial intervention should be to assess for adequate support to the cast, then elevate the limb for 30 minutes. If the pain has not diminished, document the intervention and notify the charge nurse

Manual reduction and manipulation of bones into alignment

Closed reduction

An elderly orthopedic patient refuses to perform the coughing and deep breathing exercises. He says, "I have a broken hip. There is nothing wrong with my breathing." What should the nurse do first? A. Document that the patient was instructed in the techniques but refused to do them. B. Obtain an incentive spirometer and ask the patient to try using it instead of the exercises C. Use active listening and be supportive of the patient's right to refuse a therapy D. Explain how immobility contributes to developing pneumonia or atelectasis

Explain how immobility contributes to developing pneumonia or atelectasis

Reduction of fractures and fixation to device that maintains alignment

External fixation

Used with infected fractures that do not heal properly

External fixation

The nurse is preparing to care for a patient who requires skeletal traction. The nurse knows which statement is true regarding skeletal traction? A. It uses a series of removable pins, ropes, and weights to realign bones. B. It requires nurses to frequently assess and modify the amount of weight applied. C. It has a high risk of infection. D. It is used for only fractures of the lower extremity bones.

It has a high risk of infection. *Because of the pins or wires inserted into the affected bone, risk of infection is high and pin care must be meticulously performed. Skeletal traction does not allow the nurse to modify the amount of weight applied. Skeletal traction is used for the management of musculoskeletal conditions not limited to fractures.

The appearance of a petechial rash and respiratory distress 2 to 3 days after a fracture should be reported promptly because they may be symptomatic of which life-threatening complication? A. Vitamin deficiency B. Fat embolism C. Nerve damage D. Infection

Fat embolism *Fat embolism is a rare but serious complication of a bone fracture that has an abundance of marrow fat. The fat globules released when fat-bearing bone marrow is fractured must be large enough or sufficient in number to occlude a blood vessel, either partially or completely. Rupture of small venules in the area permits entrance of fat globules into the circulation. Signs and symptoms of fat embolism include a change in mental status followed by respiratory distress, tachypnea, crackles, and wheezes that are heard when auscultating the lungs, rapid pulse, fever, and petechiae.

A patient with a plaster cast of the right arm complains of itching underneath the cast. What should you do to alleviate the symptom? A. Encourage deep breaths and scratch the other arm B. Insert a cotton-tip applicator under the cast C. Forcefully inject 50 mL of air underneath the cast D. Administer pain medications

Forcefully inject 50 mL of air underneath the cast *Forcefully injecting 50 mL of air underneath the case helps relieve itching. (1) For some people scratching the other arm will help relieve itching, and this could be suggested if the air injection isn't helpful. (2) Nothing should ever be inserted under the cast to help relieve itching. (4) Pain medication does not usually relieve itching.

Which major advantage is specific to external fixation devices? A. Faster healing time B. Allowance for immediate weight bearing C. Greater freedom of movement D. Pain reduction

Greater freedom of movement *The external device for fracture reduction allows greater freedom of movement, decreasing the problems of immobility. Healing time and pain are the same as with any other fracture reduction method

You respond to a roadside emergency and find a middle-aged man with pain and tenderness over the left leg. You note a closed bone deformity with inability to move the leg. While waiting for the paramedics, what is the most important nursing action? A. Immobilization of the leg B. Realigning the bones C. Applying warm packs D. Elevating the extremity

Immobilization of the leg *The most important action is to immobilize the leg so that bone fragments do not do more tissue damage and movement does not cause increased pain. (2) You must not try to realign the bones. (3) Warm packs are not applied to a fracture, and they would not be available in this situation. (4) Elevating the extremity, if possible, would be helpful after the leg is immobilized.

Metal appliances are used to stabilize pieces of fracture

Internal fixation

Used with older adults when brittle bones do not heal quickly

Internal fixation

Carpal tunnel syndrome (CTS) is caused when the tunnel compresses which location? A. Radial artery B. Brachial artery C. Median artery D. Ulnar artery

Median artery *When the median nerve is compressed by the carpal tunnel to the point that numbness, pain, and tingling occur, the result is CTS

A patient has come to the ambulatory care clinic with a sprain. The nurse correctly differentiates a grade 2 sprain from a grade 3 sprain with the assessment of which finding? A. Pain B. Swelling C. Bleeding into the joint D. Minor loss of function

Minor loss of function *The minor loss of function is the differentiating factor. Pain, swelling, and bleeding into the joint are true of both grade 2 and grade 3 sprains. A grade 3 sprain has the loss of function of the joint

A patient in traction for a fracture of the tibia complains of intense pain at the fracture site. The nurse assesses a temperature of 102 F and increased swelling at the fracture site. Which complication do these findings suggest? A. Osteomyelitis B. Fat embolism C. Traction misalignment D. Nonunion of the fracture

Osteomyelitis *Osteomyelitis is a bacterial infection of the bone. The causative organism is most often Staphylococcus aureus, which enters the bloodstream from a distant focus of infection, such as a boil or furuncle, or from an open wound, as in an open (compound) fracture. It is usually found in the tibia or fibula, in vertebrae, or at the site, high fever with chills, swelling of adjacent soft parts, headache, and malaise.

A young man is admitted to the emergency department after an injury to his left leg sustained playing football. He is complaining of pain around the knee and upper tibia. Which data from our assessment would indicate a fracture of the tibia rather than a connective tissue injury of the knee? A. Pain and soft-tissue swelling around the knee and an abrasion on the knee B. Pain, ecchymosis below the knee, and crepitation with any movement of the area C. Pain, swelling, and loss of function of the foot D. Limping when walking, facial grimace, and some swelling of the knee and lower leg

Pain, ecchymosis below the knee, and crepitation with any movement of the area *Signs of fracture include pain, swelling, ecchymosis into the tissues surrounding the fracture, and crepitation on movement of the affected bone. (1) An abrasion of the knee, pain, and soft-tissue swelling most likely indicate a connective tissue injury. (3) Loss of function of the foot would not occur with a fracture of the upper tibia. (4) The patient would be unable to walk with a fracture of the upper tibia due to extreme pain when trying to walk.

The nurse is caring for several patients with hip or femur fractures on an orthopedic unit. Which patient should the nurse attend to first? A. Patient complains of difficulty breathing, feeling very hot, and a fine red rash on the chest B. Patient states that pain at the surgical site is unrelieved by medication or repositioning C. Patient reports that there is an odor coming from the cast and the foot is red and swollen D. Patient says that if no one comes to help her to the bathroom, she is going to call the supervisor

Patient complains of difficulty breathing, feeling very hot, and a fine red rash on the chest

A young patient returns from the operating room after a below-the-knee amputation and is alert and quiet. The stump is elevated, with the dressing dry and intact. What is the priority problem for this patient? A. Altered body image B. Potential for bleeding C. Altered mobility D. Insufficient knowledge

Potential for bleeding *After an amputation, a risk for bleeding is a priority safety concern. (1) Disturbed body image will occur but is not the priority at this time. (3) Impaired mobility has occurred but is not the priority at this time. (4) Deficient knowledge is a probability regarding stump care, adjusting to a prosthesis, and using crutches or a wheelchair as well as maintaining balance while up but is not the priority at this time.

The nurse is caring for a patient who has had a knee replacement. On postoperative day 1, the LPN/LVN can likely anticipate which change in the plan of care? A. Quadriceps setting exercises B. Walker training C. Enemas until clear D. Cessation of pain medication

Quadriceps setting exercises *On day 1 quadriceps-strengthening exercises, and straight-leg raising are started. Quadriceps setting exercises are accomplished by lying supine, straightening the legs, and pushing the back of the knees into the bed. Exercises are taught by the physical therapist, and the nurse often assists the patient in performing them. The arthroplasty patient then progresses to ambulation with a walker or crutches. There is no need to administer enemas to the patient. Pain medication may be needed for several days after the surgery.

The LPN/LVN is caring for a patient who has had a total hip replacement. Which intervention should be implemented for this patient to help prevent dislocation? A. Secure the abduction wedge between the legs until the surgeon requests removal. B. Adjust the patient's chair so that the hips are flexed in a normal position. C. Ensure the surgical bone cement remains firmly bonded with the prosthesis. D. Assist the patient to bear weight on the operative side within the first 24 h.

Secure the abduction wedge between the legs until the surgeon requests removal. *Use of an abduction wedge in the postoperative period is needed to prevent abduction. The pillow is applied immediately after surgery in the recovery area. It is to remain in place until removal is requested by the surgeon. Weight bearing is not necessarily indicated in the first 24-h postoperative period. Normal sitting postures are to be avoided; they could potentially result in dislocation.

When assigned to care for a patient who has gout, the LPN/LVN should assess for which condition? A. Swelling and pain in the big toe or other joint B. Signs of compression of the spine from collapsed vertebrae C. Evidence of unilateral joint deformity D. Decreased range of motion of most joints

Swelling and pain in the big toe or other joint *Gouty arthritis most commonly impacts the big toe but may be noted in other joints. There are no signs of spinal nerve compression associated with the condition. Joint deformity and reduction in the range of motion of most of the body's joints are not associated with the condition.

Which vitamin is essential in treating osteoporosis? A. Vitamin A B. Vitamin D C. Vitamin B12 D. Vitamin C

Vitamin D *Standard treatments for osteoporosis include vitamin D and calcium supplementation, along with weight-bearing exercise. Vitamin A, B12, and C are not included in the standard treatment regimen for osteoporosis

Place the steps of the process of fracture healing in proper order A. Medullary canal is reconstructed B. Mature bone cells form ossification C. Callus is formed D. Granulation tissue is formed E. Hematoma is formed between broken ends of bone

1. Hematoma is formed between broken ends of bone 2. Granulation tissue is formed 3. Callus is formed 4. Mature bone cells form ossification 5. Medullary canal is reconstructed

A patient is discharged with a synthetic cast applied. What will he need to know to take care of himself and the cast? (select all that apply) A. How to assess the neurovascular status of the part encased in the cast B. How to dry the cast if it becomes wet C. Signs of infection under the cast D. Importance of reporting a broken or loose cast E. How to cut a window in the cast if there is pain or swelling F. Ways to safely scratch at the itching that will develop

1. How to assess the neurovascular status of the part encased in the cast 2. How to dry the cast if it becomes wet 3. Signs of infection under the cast 4. Importance of reporting a broken or loose cast

A young adult patient has a fractured femur with internal fixation and a long-leg cast. Which signs of potential complications should you watch for? (select all that apply) A. Infection for osteomyelitis B. Compartment syndrome C. Pneumonia or stroke D. Pulmonary fat embolus E. Electrolyte imbalance F. Nonunion of bone

1. Infection for osteomyelitis 2. Compartment syndrome 3. Pulmonary fat embolus 4. Nonunion of bone *A fat embolus is a threat when a long bone such as the femur is fractured; infection and possible osteomyelitis, compartment syndrome, and nonunion of the bone are other potential complications for which to watch. (3) Pneumonia or stroke is not likely in a young adult. (5) Electrolyte imbalance is a possibility for any patient undergoing injury and surgery but would be more likely in an older adult.

Soft-tissue injuries require the nurse to assist with or instruct about the importance of which components of care? (select all that apply) A. Bed rest B. Pain control C. Immobilization D. Activity restrictions E. Prevention of recurrence

1. Pain control 2. Immobilization 3. Activity restrictions 4. Prevention of recurrence *Bed rest is not warranted with this type of injury

You are caring for a 75-year-old female who is being treated for a new diagnosis of osteoporosis. What topics need to be included in discharge teaching? (select all that apply) A. Rationale for use and side effects of denosumab B. Diet recommendations for increased protein intake C. Calcium and vitamin D supplements D. Weight bearing exercises E. Smoking cessation F. Heath and cold for symptom management

1. Rationale for use and side effects of denosumab 2. Calcium and vitamin D supplements 3. Weight bearing exercises 4. Smoking cessation *Denosumab is a first-line treatment for women with osteoporosis; calcium and vitamin D supplements are also main treatments. Weight bearing is important for treatment and prevention. Smoking is a risk factor for osteoporosis. (2) Increasing protein will not help osteoporosis. (6) Most patients with osteoporosis do not have pain.

You are assuming recovery room care of a 52-year-old patient who had carpal tunnel repair. On receiving the patient, what is the priority nursing assessment? A. Sensation in the fingertips B. Color, warmth, and capillary refill C. Condition of the dressing D, Range of motion

Color, warmth, and capillary refill *Checking circulation in the hand by checking color, warmth, and capillary refill is the priority nursing assessment after carpal tunnel surgery. (1) Sensation in the fingertips will be important after any local anesthetic has worn off. (3) The condition of the dressing is checked but is not the greatest priority. (4) Range of motion of the wrist is not checked at this time, so soon after surgery.

Bone shattered in more than two pieces

Comminuted fracture

Bone that is in two distinct pieces

Complete fracture

Fracture bone end protruding through skin

Compound fracture

An older adult has fallen and has sprained his ankle in a local park. Which action should the responder perform first? A. Elevate the foot B. Apply ice C. Administer aspirin D. Assist the patient with ambulation

Elevate the foot *Elevation to reduce swelling is the most important initial intervention. Elevation may be done immediately. The responder will have to acquire the ice and pain medication, but should do so as quickly as possible. The responder should not attempt to ambulate the patient at this time

The nurse is at a park and observes a workman who sustains an accidental amputation of a finger. The nurse would intervene if a bystander performs which action? A. Rinses visible debris from the detached digit B. Wraps the digit in a clean, damp cloth C. Immerses the digit in a cup of cold water D. Places the digit in a plastic bag and attaches a name tag

Immerses the digit in a cup of cold water

The nurse is instructing a patient with rheumatoid arthritis about a prescribed exercise program. Which information should the nurse include? A. Perform exercises every day, 3 to 10 times for every joint B. Perform exercises even if inflammation is present C. Perform exercises past the point of pain D. Perform twice the number of exercises the next day if one day is missed

Perform exercises every day, 3 to 10 times for every joint *Exercises are essential to preserve joint function and should be done every day 3 to 10 times per joint. Exercises should be omitted if there is inflammation present and should not be take past the point of pain, or made up the next day

The nurse is performing morning care for a patient who sustained a fractured pelvis and bilateral femur fractures yesterday in a motorcycle collision. The patient complains of shortness of breath. Assessment reveals audible wheezes and oxygen saturation of 76%. What action should the nurse take first? A. Establish a peripheral intravenous (IV) line B. Inform the charge nurse C. Explain the patient's change in status to his family D. Raise the patient to high Fowler's position

Raise the patient to high Fowler's position *Fat embolism is a rare but serious complication of a fracture of a bone that has an abundance of marrow fat (e.g., the long bones, pelvis, and ribs). In the early post injury period, patients with multiple fractures resulting from severe trauma are at risk for this complication. Signs and symptoms of at embolism include a change in mental status, respiratory distress, tachypnea, crackles and wheezes on auscultating the lungs, rapid pulse, fever, and petechiae (a fine red rash over the chest, neck, upper arms, or abdomen). The nurse should stay with the patient; put him in high Fowler, use a non-rebreather mask to give high-flow oxygen, and establish a peripheral IV line. The nurse should summon the physician immediately as there is about an 80% mortality rate from this complication. Raising the patient to high Fowler position is the best initial intervention as it can be done immediately. The nurse should then verify patent IV access, notify the charge nurse and physician, and update the family on the patient's status change

The nurse is caring for a patient who just returned from surgical decompression of the carpal tunnel. Which finding requires the nurse's immediate action? A. The patient's fingers swollen and warm B. The patient complains of generalized pain 5/10 C. The capillary refill time is 8 seconds D. The patient's fingers are pink and cool bilaterally

The capillary refill time is 8 seconds *A capillary refill of over 5 seconds is an indication of diminished perfusion. Pain and swelling are to be expected, and pink but cool fingers bilaterally do not indicate circulatory compromise

The nurse is performing an assessment on the patient who is in bilateral Buck traction. Which finding indicates the need to reposition the patient? A. The patient's heels are not touching the surface of the mattress B. The elastic bandages need to be rewrapped C. The patient's feet are against the footboard D. The weights are hanging free

The patient's feet are against the footboard *When the patient's feet are against the footboard, the traction is ineffective. The heels should be off the surface of the mattress to reduce the threat of pressure ulcer. The weights should be hanging free

The patient presents to the emergency department after a soccer game. The patient reports that she made a sharp turn and heard and felt a large pop from her knee. The patient reports, "Now, when I'm walking, it feels like my knee just gives out, and I almost fall. Plus, it's twice the size of my other knee, and I can't straighten it all the way." The nurse recognizes that these symptoms correspond with which injury? A. Torn meniscus B. Dislocated patella C. Torn quadriceps muscle D. Torn anterior cruciate ligament injury

Torn anterior cruciate ligament injury *The turning motion followed by a loud pop with the patient's complaint of severe swelling, joint instability, and decreased extension indicates a torn anterior cruciate ligament. A meniscal tear has less swelling and joint instability, although some exists. If the patient had dislocated her patella, the patella would be in a different spot than normal, and this would be part of the patient's chief complaint. The patient's complaint centers on the knee, not the quadriceps.

You are assisting an older adult, in his or her home, who has rheumatoid arthritis in the hands and wrists. You would intervene to teach the patient about joint protection if the patient A. turned the doorknob counterclockwise B. Used the palms of the hands to push up and off the bed C. Carried groceries into the house using both hands D. Pushed the door open with the arm

Used the palms of the hands to push up and off the bed A patient with rheumatoid arthritis in the hands and wrists should not use the palms of the hands to push up off the bed, as this puts undue pressure on the wrists. (1) Turning the doorknob in either direction should be done slowly and gently to prevent pain in the fingers and wrists. (3) Groceries should be carried using both arms and hands and by holding packages close to the chest. (4) Pushing the door open with an arm rather than the wrist and hand is appropriate.

LPNs/LVNs can do much to decrease the incidence of osteoporosis by teaching all female patients that preventive measures include sufficient calcium intake and which other intervention? A. Weight-bearing exercises B. Supplemental B vitamins C. Total avoidance of alcohol D. Sufficient fluid intake

Weight-bearing exercises *Health promotion activities geared to reduce the risk of osteoporosis include weight-bearing exercise. Weight-bearing exercise increases bone health. The supplementation of vitamin B intake will not prevent osteoporosis. Fluid intake is positive for overall health. Drinking in moderation is not associated with the onset of osteoporosis.

A difference in the postoperative care of a patient with a knee replacement compared with a patient with a hip replacement is that the patient with a hip replacement A. has less chance of developing a deep vein thrombosis B. has less difficulty with pain control C. is allowed to stand at the bedside on the first postoperative day D. has a CPM machine to exercise the joint

has less difficulty with pain control *The patient with a hip replacement has less tissue injury and generally has well controlled pain (1) Both patients have a risk of developing a deep vein thrombosis. (3) Both patients are out of bed on the first postoperative day. (4) Only the patient with a knee replacement has a continuous passive motion machine to exercise the joint.