Med/Surg Chp 43

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain?

Administer prescribed analgesics around-the-clock

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear?

Difficulty lying on affected side

Which of the following disorders results in widespread hemorrhage and microthrombosis with ischemia?

Disseminated intravascular coagulation (DIC)

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

"I don't know if I'll be able to get off that low toilet seat at home by myself."

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

"Apply ice packs for the first 24 to 48 hours, then apply heat packs."

A client with a fracture develops compartment syndrome that requires surgical intervention. The nurse would most likely prepare the client for which of the following?

Fasciotomy

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?

Elevating the stump for the first 24 hours

The nurse is assessing a patient's knee. The area has a grating sensation. This would be documented as which of the following?

crepitus

Which type of fracture involves a break through only part of the cross-section of the bone?

incomplete

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in his cast care?

keep right leg elevated above heart

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment?

nonunion

A fracture is termed pathologic when the fracture

occurs through an area of diseased bone

A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient?

Hypovolemic shock

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching?

I'll make sure to keep my ankle elevated as much as possible."

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?

Impacted

Elderly clients who fall are most at risk for which injuries?

Pelvic fractures

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

Prevent internal rotation of the affected leg.

Which of the following may occur if a client experiences compartment syndrome in an upper extremity?

Volkmann's contracture

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

With the leg on the affected side abducted

A nurse advises a patient with a casted femur fracture to check for signs of a fat embolism. She tells the patient that the onset of symptoms for FES occur:

Within 12 to 48 hours.

Which intervention should the nurse implement, when caring for the client who complains of phantom limb pain two months after amputation?

Reassure the client that phantom pain is common.

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. The nurse would suspect which of the following?

Avascular necrosis

An x-ray demonstrates a fracture in which a bone has splintered into several pieces, which type of fracture is this?

Comminuted

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?

Comminuted

Two days after application of a cast to treat a fractured femur, the patient tells the orthopedic heath care provider that he is experiencing severe, deep, and constant pain in his leg. The nurse suspects a diagnosis of:

Compartment syndrome.

A patient was climbing a ladder, slipped on a rung, and fell on the right side of the chest. X-ray studies reveal three rib fractures, and the patient is complaining of pain with inspiration. What is the anticipated treatment for this patient?

Coughing and deep breathing with pillow splinting

The patient presents to the emergency room with an open fracture of the femur. Which action would the nurse implement to prevent the most serious complication of an open fracture?

Cover the wound with a sterile dressing to prevent infection.

Colles' fracture occurs in which of the following areas?

Distal radius

The nurses instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client?

Do not flex the hip more than 90 degrees

A 16-year-old female is brought to the clinic by her mother who is concerned about her daughter's complaints of pain in her arm. The client is a member of her high school crew team and practices for 2 ½ hours every day after school. Which of the following would the nurse suspect?

Epicondylitis

A client is diagnosed with carpal tunnel syndrome. Which of the following assessment findings would the nurse expect?

Inability to flex index and middle fingers

A 39-year-old softball player has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would you expect the physician to perform?

Joint manipulation and immobilization

A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?

Keeping a pillow between the client's legs at all times

Pulselessness is a very late sign of compartment syndrome and may signify which of the following?

Lack of distal tissue perfusion

Which of the following is an inaccurate clinical manifestation of a fracture?

Lengthening

Which of the following is a factor that inhibits fracture healing?

Local malignancy

When caring for a client with a fracture, assessment of which of the following would be the priority

Neurovascular compromise

A patient with a traumatic amputation of the right lower leg is refusing to look at the leg. Which of the following actions by the nurse is most appropriate?

Provide feedback on the patient's strengths and available resources.

Which nursing diagnosis takes highest priority for a client with a compound fracture?

Risk for infection related to effects of trauma

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain?

Rotator cuff tears

A client sustains an injury to the ligaments surrounding a joint. The nurse identifies this as which of the following?

Sprain

A 45-year-old softball player arrives at the emergency department following his injury while sliding into a base during a game. After his examination and radiographs, the physician diagnoses muscle strain and prescribes appropriate treatment. What does the physician mean with the term "strain"?

Stretched or pulled beyond its capacity

An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as?

Subluxation

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for:

cap refill

Which assessment findings would the nurse expect to find in the postoperative client experiencing fat embolism syndrome?

column B

When the patient who has experienced trauma to an extremity complains of severe burning pain, vasomotor changes, and muscles spasms in the injured extremity, the nurse recognizes that the patient is likely demonstrating signs of

complex regional pain syndrome.

A client who suffers an injury in a local high school hockey game presents with left shoulder pain. The client cannot move the left arm, and the left shoulder is lower than the right shoulder. The nurse recognizes the client most likely has a:

dislocated shoulder

A 39-year-old client has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicated intact but malpositioned bones, what would you expect the physician to diagnose?

dislocation

A nurse is developing a teaching plan for a client who must undergo an above-the-knee amputation of the left leg. After a leg amputation, exercise of the remaining limb:

should begin the day after surgery.

Which of the following terms refers to an injury to ligaments and other soft tissues of a joint?

sprain

The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture should be included? (Select all that apply.)

• Checking the urine for hematuria • Palpating peripheral pulses in both lower extremities • Testing the stool for occult blood

A nurse is caring for a patient who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.)

• Encouraging the patient to care for the residual limb • Allowing the expression of grief • Introducing the patient to local amputee support groups.

A 75-year-old patient had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which of the following complications? Select all that apply.

Pneumonia • Skin breakdown • Sepsis • Delirium

The nurse is caring for a patient who sustained an open fracture of the right femur in an automobile accident. What does the nurse understand is the most serious complication of an open fracture?

infection

A professional tennis player comes to the orthopedic clinic and informs the nurse that he is having pain that radiates down the forearm and is unable to grasp the racket firmly. What does the nurse suspect is occurring with the client?

Epicondylitis

The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding?

Clawlike deformity of the right hand without ability to extend fingers

Which laboratory study is most relevant to treating a client who has sustained a pelvic fracture?

Type and crossmatch

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include:

inability to perform active movement and pain with passive movement.

A patient suffered an open fracture to the left femur during a horse-riding accident. For which of the following complications is this patient at highest risk?

infection

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention?

compound

Which of the following is a hallmark sign of compartment syndrome?

pain

A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes the patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse understand is likely occurring with this patient?

fat emboli

When evaluating for hypovolemic shock, the nurse should be aware of which of the following clinical manifestations?

hypotension

A client comes to the Emergency Department complaining of localized pain and swelling of his lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely?

contusion

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures?

hemorrhage and shock

A client presents to the emergency department gently holding the left arm, which is slightly swollen and painful to the touch. Based on these findings, the nurse:

Elevates the arm and applies an ice pack