MED/SURG2: Chapter 62

When teaching a group of young adults, what general measures should a nurse teach to prevent injuries?

-Avoid drunken driving -Use seat belts regularly -Use safety equipment at work -Use protective athletic equipment A nurse plays a pivotal role in teaching patients to take appropriate measures to prevent injuries. Some of these measures include regularly using seat belts, avoiding drunken driving, using protective athletic equipment (helmets and knee, wrist, and elbow pads), and using safety equipment at work. Obeying the speed limit is sufficient; the nurse does not need to teach that people should always drive slower than the speed limit. The teaching should encourage people not to use the phone at all while driving; if an important call must be made, the driver should find a safe place to stop before making it. p. 1475

The nurse assists in performing annual well visits for four patients. Which patient is least likely to develop overuse syndrome?

A football player Repetitive strain injury (RSI) may result from prolonged force or repetitive movements and awkward postures. The repeated movements strain the tendons, ligaments, and muscles, causing tiny tears. It may result in inflammation, swelling, and pain in the muscles and nerves of the neck, shoulder, forearm, and hand. Persons at risk for RSI include dancers, musicians, grocery clerks, and workers who use power tools that cause vibration. The football player is least likely to develop this condition. p. 1465

What is the best intervention to prevent infection in a patient who has sustained an acute knee injury and has an open wound?

Administering tetanus prophylaxis Tetanus prophylaxis is administered when the patient has an open wound and an increased risk of infection. Application of ice may help relieve pain. Analgesics may help to relieve pain. Immobilizing the extremity helps in providing comfort. p. 1474

A patient experiences a traumatic tear of ligament caused by an excessive deceleration force combined with rotation of the limb. What diagnosis does the nurse suspect?

Anterior cruciate ligament tear An anterior cruciate ligament tear is the traumatic tearing of the ligament by excessive deceleration forces together with pivoting or rotating positions of the knee. Ligament injury can be described as traumatic tearing and stretching of a ligament as a result of excessive torque applied to the joint. Meniscus injury to the fibrocartilage of the knee is characterized by popping, clicking, tearing sensation, effusion, and swelling. A rotator cuff tear is a tear within muscle or tendinoligamentous structures around the shoulder. p. 1467

A patient is being treated for a vertebral injury. After the application of a body brace jacket, the patient reports abdominal pain and pressure, nausea, and vomiting. What is the nurse's priority assessment?

Assess the abdomen for decreased bowel sounds through a window in the brace The patient is being treated for a vertebral injury with a body brace jacket. Monitoring the abdomen is necessary to observe decreased bowel sounds through a window present in the brace. This symptom occurs if the brace is applied too tightly, compressing the superior mesenteric artery against the duodenum. Monitoring vital signs and comparing pulses help to identify differences in rate or quality but are not the priority. Monitoring for temperature elevation and other signs of infection are important but are not the priority. Monitoring for excessive pain with passive stretching of the affected extremity's muscles, pallor, paresthesia, and late signs of paralysis and pulselessness is done to check for compartment syndrome. p. 1472

The nurse is assessing a patient who has a traumatic leg injury. What intervention is the most important in the initial assessment?

Determine the extremity's color and temperature in the area of the injury Baseline assessments are very important. It is most important to assess the extremity's color and temperature in the area of the injury to determine any venous or arterial insufficiency. If arterial or venous blood flow in the area is blocked, the area could become ischemic and die. Assessment of temperature is crucial to determine circulation and perfusion to the extremity and any change in temperature in the extremity should be reported promptly to the health care provider. Assessing the patient's pain is important but not as crucial as determining any arterial insufficiency. Realigning the injured extremity can lead to further damage or cause vascular insufficiency. Loss of sensation may be a late sign of neurovascular damage. p. 1474

The nurse formulates a nursing diagnosis of impaired physical mobility related to decreased muscle strength for a patient who has undergone a total knee replacement. What is an appropriate nursing intervention for this patient?

Encourage isometric exercises every six hours Great emphasis is placed on postoperative exercise of the affected leg, with isometric quadriceps setting beginning on the day after surgery. The leg does not need to stay in an abducted position, which would be used following hip replacement surgery. The patient should not bear weight on the extremity until instructed to do so by the health care provider. Calcium supplementation will not impact physical mobility. p. 1491

The nurse formulates a nursing diagnosis of impaired physical mobility related to decreased muscle strength for a patient following left total knee replacement. What would be an appropriate nursing intervention for this patient?

Encourage isometric quadriceps-setting exercises at least four times daily. Emphasis is placed on postoperative exercise of the affected leg, with isometric quadriceps setting beginning on the first day after surgery along with a continuous passive motion (CPM) machine. Vitamin C and calcium do not improve muscle strength, but they will facilitate healing. The patient should be able to do active range of motion to all joints. Keeping the leg in one position (extension and abduction) potentially will result in contractures. p. 1491

A patient status post right total knee arthroplasty has a prescription to get out of bed to the chair. Which action would the nurse take to protect the knee joint while carrying out the prescription?

Ensure a knee immobilizer is in place and elevate the leg while sitting The nurse should apply a knee immobilizer for stability before helping the patient out of bed. This is a standard measure to protect the knee during movement after surgery. A mechanical lift would not be necessary, because the patient can fully weight bear on the unaffected leg. A walker and assistance from the physical therapist may be considered, but the priority action would be to stabilize the knee and elevate it while sitting. p. 1491

This morning a patient had a long leg cast applied and wants to get up and try to practice crutch walking. What is the best rationale that the nurse should give the patient for not allowing the patient to perform this task?

Excess edema and other problems are prevented when the leg is elevated for 24 hours For the first 24 hours after a lower extremity cast is applied, the leg will be elevated on pillows above the heart level to avoid excessive edema and compartment syndrome. The cast also will be drying during this 24-hour period, although it will not be damaged by use of crutches. The lack of having someone to accompany the patient is important for safety, but is not the most important reason. RICE is used for soft tissue injuries, not with long leg casts. p. 1473

Which type of adult is at an increased risk for carpel tunnel syndrome (CTS)?

Female with diabetes mellitus Patients with diabetes mellitus have greater incidence of CTS. Women have smaller carpel tunnels compared to men and are more prone to develop CTS. Men and women with asthma as well as men with glaucoma are at a lesser risk for CTS. p. 1466

The nurse is caring for a patient with a spinal bone fracture and osteoporosis. The patient asks the nurse for information on osteoporosis. What is the most appropriate response by the nurse?

For many people, diseases such as osteoarthritis and osteoporosis are not a normal part of growing older These two bone diseases are not a normal part of aging for many people. In the aging adult, tendons and ligaments become less flexible, leading to more rigid movement. By age 70, a person's muscle mass is reduced by almost 30 percent. The number of motor neurons decrease, which leads to more physical problems. p. 1468

A patient arrives in the emergency department after sustaining a fall. The initial assessment reveals that the left leg is shorter than the right and externally rotated. What condition should the nurse suspect?

Fractured hip Older adults, especially women, are at high risk for fracture. One classic sign of a fractured hip is a leg that is shorter than the opposite one and abnormally rotated (internally or externally). A fractured hip is accompanied by pain and possibly neurovascular changes. A leg that is shorter than the other one and externally rotated is not a sign of a fractured pelvic, femur, or tibia/fibula. p. 1482

A patient is hospitalized with severe bleeding in the leg. An x-ray exam of the leg reveals that the periosteum is intact across the fracture and that the bone is still in alignment. What type of fracture does the patient have?

Greenstick fracture A nondisplacement fracture in which the periosteum is intact across the fracture and the bone is still in alignment is classified as a greenstick fracture. In an oblique fracture, the line of the fracture extends in an oblique direction. A pathologic fracture is a spontaneous fracture at the site of a bone disease. Displaced fractures are usually comminuted fractures in which there are more than two bone fragments with the smaller fragments floating or oblique. p. 1469

Which type of fracture is most common in older adults?

Hip fracture Hip fractures are most common in older adults, with 90 percent of these fractures occurring as a result of a fall. Colles' fracture is a fracture of the distal radius and is one of the most common fractures in adults. Pelvic fractures range from benign to life threatening, depending on the mechanism of injury and associated vascular insult. Only a small percentage of all fractures are pelvic fractures. This type of injury is associated with a high mortality rate. Fractures of the humerus involve the shaft of the humerus, and are common among young and middle-aged adults. p. 1481

The patient is brought to the emergency department after a car accident and has a femur fracture. What nursing intervention should the nurse implement to prevent a fat embolus in this patient?

Immobilize the fracture preoperatively To prevent fat emboli, the nurse immobilizes the long bone to reduce movement of the fractured bone ends and decrease the risk of a fat embolus from the bone before surgical reduction. Enoxaparin is used to prevent blood clots, not fat emboli. Range of motion and compression boots will not prevent a fat embolus in this patient. p. 1476

A nurse is caring for a patient who has just sustained a hip fracture. Which nursing action should be performed first?

Immobilizing the affected extremity The priority of emergency management for a fractured hip is immobilizing the affected extremity, because movement could cause further damage and more extensive internal bleeding and worsen the patient's pain. Administering pain medication, preparing the patient for immediate surgery, and placing the injured extremity in traction are secondary nursing interventions that require further direction from the primary health care provider. p. 1468

The nurse cares for a patient who experiences a severe hip injury. What condition places the patient at risk for avascular necrosis?

Inadequate blood supply to the bone A posterior hip dislocation due to severe injury may result in avascular necrosis if the joints remain unreduced for a long time. The dislocated parts may block the blood supply to the bone, resulting in bone death and necrosis. The open joint injuries are susceptible to infection but are not associated with avascular necrosis. Intraarticular injuries are another complication of dislocation and may not be related to avascular necrosis. The adjacent neurovascular tissue will be manifested by altered neurovascular status. p. 1482

A patient experiences delayed bone healing. What function does the nurse identify as helpful by electrical bone growth stimulation?

Increases the calcium uptake of bones Electrical bone growth stimulation is used to facilitate the healing process for certain types of fractures. This includes those with delayed bone healing by increasing the calcium uptake of the bone. Electrical bone growth stimulation helps in activating the intracellular calcium stores and does not decrease the calcium uptake of the bone. Electrical bone growth stimulation leads to an increase in the production of bone growth factors. p. 1474

A patient with osteoarthritis is preparing for a total left-knee arthroplasty. The nurse assesses the patient carefully to be sure that there is no evidence of which sign in the preoperative period?

Infection It is critical that the patient be free of infection before a total knee arthroplasty. An infection in the joint could lead to even greater pain and joint instability, requiring extensive surgery. For this reason, the nurse monitors the patient for signs of infection, such as redness, swelling, fever, and increased white blood cell count. Pain, immobility, and inflammation are common findings in the patient with osteoarthritis and would not be contraindications to surgery. p. 1492

What is a meniscus injury?

Injury to fibrocartilage of the knee A meniscus injury refers to injury to the fibrocartilage of the knee that is characterized by popping, clicking, and tearing sensations with effusion and swelling. The traumatic tearing of ligaments by excessive deceleration forces together with pivoting or rotating positions of the knee or leg is an anterior cruciate ligament tear. Tearing or stretching of ligaments as a result of excessive inversion, eversion, shearing, or torque applied to a joint is described as ligament injury. Injury to the muscle or tendinoligamentous structures around the shoulder is called a rotator cuff tear. p. 1467

A patient's x-ray exam reveals that there is no evidence of callus formation after the second week of treatment for a bone fracture. What does the nurse infer related to healing of the fracture?

It is failing to heal despite treatment During the second week of treatment after a bone fracture, an x-ray is performed to check for the presence of callus formation. Callus formation indicates that the healing process of the bone has started. Absence of callus formation indicates failure of the healing process in spite of treatment. When the fracture healing progress is slower than expected over time, it indicates a delayed union of the fractured bone. The fracture is not healing normally. When the fracture heals in an abnormal position in relation to the midline of the structure, it indicates angulation. p. 1470

A patient has presented with an unstable wrist fracture. What kind of cast is best for this patient?

Long arm cast The long arm cast is commonly used for stable forearm or elbow fractures and unstable wrist fractures. It is similar to the short arm cast but extends to the proximal humerus, restricting motion at the wrist and the elbow. The sugar-tong posterior splint accommodates post injury swelling in the fractured extremity. A short arm cast is used for stable wrist fractures. The sugar-tong splint is typically used for acute wrist injuries or injuries that may result in significant swelling. p. 1472

A bandage has been applied on the ankle of a patient for a sprain. The patient states the ankle is swollen, numb, and painful. What is the priority action by the nurse?

Loosen the bandage The patient's signs and symptoms indicate that the bandage is too tight. In such cases, the bandage can be left in place for 30 minutes and then removed for 15 minutes. However, some elastic wraps are left on during training, athletic, and occupational activities. Although assessing for thrombophlebitis, deep vein thrombosis, and cellulitis can all cause pain and swelling, the differential diagnosis in this instance points to bandage tightness as the likeliest cause. Ambulation will increase the pain and swelling until the bandage is loosened. p. 1464

The nurse is completing discharge teaching with an older adult patient who underwent right total hip arthroplasty. The nurse identifies a need for further instruction if the patient states the need to do what?

Maintain hip in adduction and internal rotation The patient should not force the hip into adduction, or force the hip into internal rotation, because these movements could displace the hip replacement. Avoiding crossing the legs, using a toilet elevator on a toilet seat, and notifying future caregivers about the prosthesis indicate understanding of discharge teaching. p. 1492

A patient experiences a knee fracture. During a follow up visit, the patient reports an increase in muscle spasms. Which action performed by the patient may be the cause of the spasms?

Massaging the muscle Massaging the muscle during spasms may stimulate muscle tissue contraction, which may lead to an increase in muscle spasms. Applying a bandage is not likely to increase muscle spasms. Applying a heat compress to the muscle may help decrease the spasms and pain. Performing range-of-motion exercises would not affect the muscle spasms. p. 1478

A patient underwent osteotomy a few days ago. Which postoperative nursing action is suitable for the patient at this time?

Perform neurovascular assessment. Neurovascular assessment should be performed to assess nerve function and circulatory status. Intramuscular antibiotics are administered during the initial acute injury period, not after several days. The patient needs to be monitored for any limitations of movement or activity related to turning, positioning, and extremity support. Splints are used above and below the fractured site initially to reduce range of motion that might result in further complications. So, sitting, standing, and walking should be discouraged. p. 1492

The nurse determines that the patient undergoing a total left-knee arthroplasty is likely to have the best overall outcome of this procedure if the patient exhibits which indicator before surgery?

Positive coping skills Research has demonstrated that the patients who have the best outcomes after joint replacement surgery are those with a sense of self-efficacy and positive coping skills. Family support, pain control, and knowledge of the procedure are also important components to the healing process. p. 1492

What is the best intervention for a patient with an anterior cruciate ligament (ACL) injury who evidences tight and painful effusion?

Preparing for aspiration The anterior cruciate ligament injury may involve a tear from the bone attachments that form the knee. The patient may report a tight and painful effusion, and a joint aspiration may be needed. Application of ice interferes with transmission of pain impulses and may not help in joint effusion. Elevation of the knee relieves edema. Nonsteroidal antiinflammatory drugs (NSAIDs) such as aspirin may relieve the pain at the injury site, but may not relieve effusion. p. 1468

The nurse is caring for a patient who has undergone left knee arthroplasty with prosthetic replacement of the knee joint to relieve the pain of severe osteoarthritis. Postoperatively, what does the nurse expect to be included in the care of the affected leg?

Progressive leg exercises to obtain 90-degree flexion Although early, full weight bearing ambulation is not recommended, the patient is encouraged to engage in progressive leg exercises until 90-degree flexion is possible. Because this is painful after surgery, the patient requires good pain management and often the use of a continuous passive motion (CPM) machine. The patient's knee is unlikely to dislocate. The knee will not be immobilized for two weeks at 30-degree flexion. p. 1491

A patient with a hip fracture has symptoms such as severe pain and tenderness around the fractured area. What is the prioritized treatment goal following hip arthroplasty?

Receiving relief from the pain After a hip arthroplasty, the priority of the treatment is to relieve pain to the patient's stated comfort goal. Abduction, not adduction, of the hip should be maintained postoperatively to avoid displacement of the hip. A physical therapist introduces exercise therapy gradually to restore muscle tone. Quadriceps and muscles about the hip are essential to improve function and range of motion. It is important for the patient to understand and follow the prescribed plan of treatment for a speedy recovery. p. 1491

A nurse evaluates a patient who reports twisting an ankle while walking down steps. Besides edema, which symptoms would most likely be observed if a nondisplaced simple fracture were present?

Redness, warmth, and inability to use the affected part Common signs of a fracture include edema, redness, warmth, inability to bear weight or use the affected joint, and pain at the site of injury. Coolness, tingling, numbness, and loss of pulses are signs of a vascular problem or may reflect a complication of a more complex fracture. p. 1468

Which type of surgical repair is performed during hemiarthroplasty?

Replacement of part of the femur with prosthesis Hemiarthroplasty is a surgical replacement of part of a joint. Replacement of part of the femur with a prosthesis is known as hemiarthroplasty. Reshaping of the femoral head is done during hip resurfacing in which the femoral head is reshaped rather than replaced. Repair of the joints with internal fixation is done through devices such as pins, plates, and intramedullary rods that are inserted into the joint to attain the correct bone alignment. The replacement of both femur and acetabulum is performed during a total hip arthroplasty. p. 1483

The nurse is providing discharge education to a patient with a fiberglass cast. What should the nurse be sure to include with the education?

Skin irritation is more common than with a plaster cast Although there are many advantages of fiberglass casts, such as its capacity to withstand wetness and its lightness compared to plaster, the one major disadvantage is that the particles of fiberglass may be irritating to the skin. A fiberglass cast is water-repellent and does not require replacement if it becomes wet. A fiberglass cast may remain on the patient for the duration of the treatment and does not require replacement every one to two weeks. A fiberglass cast is lighter than plaster. p. 1477

The nurse is providing postoperative care to a patient who underwent surgical repair of a fractured hip two days ago. Which assessment finding indicates the need for immediate nursing action and intervention?

Sudden shortness of breath The sudden onset of shortness of breath could be an indication of fat embolism syndrome, a potentially fatal complication of long bone fractures. Pain at the surgical site, serosanguineous wound drainage, and limited range of motion of the affected leg are all expected findings in a patient who has just undergone repair of a fractured hip. p. 1483

What action should a nurse implement to prevent foot drop in a patient who has a full-leg cast?

Support the foot with 90 degrees of flexion As a means of preventing foot drop in a leg with a cast, the foot should be supported with 90 degrees of flexion. Encouraging bed rest for his patient is not required. Supporting the foot with 45 degrees of flexion will not prevent foot drop. Antiembolic garments will protect against thromboembolic events but not foot drop. p. 1478

A patient is suffering from inflammation in the joints of fingers, wrists, feet, and ankles that results in painful deformity, especially in the knees. Which type of surgery is indicated as a palliative treatment for this patient?

Synovectomy The symptoms of inflammation in the joints of fingers, wrists, feet, and ankles, along with painful deformity in the knees, indicate a surgical synovectomy to remove damaged, inflamed synovial membranes. Osteotomy has proven ineffective in patients with inflammatory joint disease. Arthrodesis is the fusion of a joint when joint replacement surgery fails. Arthroplasty is the reconstruction or replacement of a joint. p. 1490

A patient with profound osteoarthritis is recommended for total hip arthroplasty (THA). The patient asks why this will relieve the discomfort. What is the nurse's best response?

THA can provide significant pain relief for patients with joint deterioration from arthritis by replacing the ball-and-socket joint as well as the upper shaft of the femur. An arthroplasty is a procedure that relieves pain and promotes mobility by reconstructing or replacing a joint; a THA removes the ball-and-socket joint and the upper shaft of the femur. A hip resurfacing arthroplasty is an alternative to THA that allows the ball of the joint to be preserved and reshaped. An osteotomy removes a wedge or slice of bone to restore alignment and shift weight-bearing, thus relieving pain. A debridement procedure removes degenerative debris from the join to relieve pain and promote mobility. p. 1491

The nurse suspects that a patient is experiencing a fat embolism after sustaining a femur fracture. What clinical manifestations does the nurse expect?

Tachypnea, tachycardia, shortness of breath, petechial rash on the chest and neck A fat embolism may occur in a patient who has had a fracture of a large bone such as a femur or hip. The classic symptoms of a fat embolism include tachypnea, tachycardia, shortness of breath, and petechial rash on the chest and neck. Tachypnea, tachycardia, shortness of breath, and paresthesias; paresthesias, bradycardia, bradypnea, and petechial rash; and bradypnea, bradycardia, shortness of breath, and petechial rash are not directly characteristic of a pulmonary embolism. p. 1480

What is carpel tunnel syndrome (CTS)?

The compression of the median nerve that enters the hand through the narrow confines of the carpal tunnel CTS involves the compression of the median nerve, which enters the hand through the narrow confines of the carpal tunnel. A rotator cuff tear is a tear within the muscle or tendinoligamentous structures around shoulder. The entrapment of soft tissue structures under the coracoacromial arch of the shoulder is impingement syndrome. The injury to fibrocartilage of the knee, characterized by popping, clicking, tearing sensation; effusion; and swelling, is a meniscus injury. pp. 1465-1466

A patient with a history of a cervical injury frequently works at a desk and uses a computer. The patient reports a recurrence of pain and stiffness in the neck. Which action may be the cause of the symptoms?

The patient elevates the wrist when typing. The patient with a cervical injury who frequently works at a desk and uses the computer may suffer from a repetitive strain injury from repetitive movements and awkward positions of the wrist. Taking hourly stretch breaks helps in promoting circulation. The computer monitor's top should be kept even with the forehead to keep the neck muscles from straining. The hips and knees should be kept flexed at 90 degrees with the feet flat. p. 1465

On return from surgery, the patient is wearing intermittent sequential compression stockings that the patient does not want to keep on. How should the nurse explain their necessity to the patient while on bed rest?

The stockings provide compression of the veins to keep the blood moving back to the heart Intermittent sequential compression stockings provide compression of the veins while the patient is not using skeletal muscles to compress the veins, which keeps the blood moving back to the heart and prevents blood pooling in the legs that could cause deep vein thrombosis. The warmth is not important. Blood flow to the legs is not maintained. Blood pressure is not decreased with the use of intermittent sequential compression stockings. p. 1492

A patient with a fracture of the femur has the extremity in skeletal traction and is encouraged to use an overhead trapeze apparatus. The nurse explains that the primary purpose of the overhead trapeze is what?

To facilitate independent movement while the patient is in bed An overhead trapeze will facilitate independent movement in bed. It also maintains range of motion of the upper extremities and strengthens the biceps. Assisting with stump exercises, enhancing breathing and lung expansion, and promoting circulation throughout the body are secondary benefits to using an overhead trapeze but are not the primary purpose. pp. 1476, 1478

As part of a wellness program, the nurse recommends balancing exercises. What should the nurse explain as the primary benefit of the exercises?

To prevent falls Balancing exercises help to prevent falling. Bone density is not built by balancing exercises. Strengthening exercises may help build bone density and muscle strength. Balancing exercises may not help in maintaining normal blood pressure. p. 1484

Which drug is monitored via measurement of prothrombin time in patients who undergo orthopedic surgeries?

Warfarin Prothrombin time is measured daily, starting on the day of the surgery, when a patient is taking warfarin. Low-molecular-weight heparin drugs such as enoxaparin, rivaroxaban, and fondaparinux do not require prothrombin time testing on a daily basis. p. 1492

When teaching a group of athletes about reducing the risk of sprains and strains before vigorous exercise, what instructions should the nurse include?

Warm up before exercise Warming up muscles before exercising and vigorous activity, followed by stretching, may significantly reduce the risk of sprains and strains. Resting before vigorous exercise may cause sprains and strains. In this group of athletes, vigorous exercise can be done, but it should be done after appropriate warming up. Resting after the exercise does not affect the risk of strains and sprains. p. 1463

Which joint is considered an ideal site for surgical fusions?

Wrist joint Arthrodesis is the surgical fusion of a joint. Common areas of joint fusions are the wrist, ankle, and cervical spine. The hip, knee, and elbow joints are not considered ideal sites for surgical fusion, because fusion of those joints will lead to immobility. p. 1492

The registered nurse teaches a student nurse about care of a patient with a fracture of the humerus, compartment syndrome, and a plaster cast in place. The student nurse provides discharge education to the patient. Which statement made by the student nurse needs correction?

"Elevate the extremity above the heart level." Elevation of the extremity above the heart level is contraindicated for patients with compartment syndrome, which is a painful condition that occurs when the pressure within the muscle increases to dangerous levels. If the cast gets wet by mistake, it should be dried thoroughly using a hair dryer on the low setting. Itching is a common sensation experienced by patients and can be controlled by using a hair dryer on the cool setting instead of using hard objects to scratch the area. The patient should not cover the cast with plastic for prolonged periods. p. 1479

A soccer player has injured the anterior crucial ligament (ACL) and is having reconstructive surgery. The nurse knows that the patient will need more teaching when the patient makes which statement?

"I can't wait to get this done now so I can play soccer for the next tournament." When the athlete has ACL reconstructive surgery, the patient does not understand the severity when the patient mentions planning to be back to playing soccer soon. The patient likely will not be able to play soccer for six to eight months. The patient will be able to do range of motion soon after surgery. Immobilization and progressive weight bearing with physical therapy will occur during rehabilitation. p. 1468

The nurse provides discharge instructions to a patient who has undergone total hip arthroplasty. Which statement by the patient indicates understanding of the instructions?

"I have to do the physical therapy exercises several times a day." After hip arthroplasty (replacement), the patient must perform specially designed exercises to help regain muscle strength. Care must be taken to prevent dislocation of the prosthesis and to prevent fatigue during the recovery period. Walking two miles per day and taking bike rides would put too much physical stress on the patient. Slow but steady progress will indicate when the patient's activity tolerance level is such that he or she may return to work. p. 1491

The registered nurse is teaching a student nurse about the postoperative management care for a patient who has undergone knee arthroplasty. Which statement given by the student nurse is most important for knee arthroplasty?

"I will emphasize isometric quadriceps exercises on the first postoperative day." Emphasizing isometric quadriceps on the first postoperative day is particular to knee arthroplasty. Assessment of vital signs is a general precautionary method after any surgery. Assessment of the respiratory rate checks for any airway complications following surgery. Restricting the patient from doing active flexion exercises initially is appropriate but is not as high a priority as isometric exercises. p. 1491

A nurse applies an elastic bandage to a patient's knee and provides discharge instructions after teaching the patient how to reapply the bandage. Which statement made by the patient indicates the need for further teaching?

"I will leave it in place for prolonged periods." The elastic bandage should not be wrapped for prolonged periods, because it may irritate the area and cut off circulation. The bandage should not be wrapped too tightly, because it may interfere with the blood supply and cause numbness. The ideal way of wrapping the bandage is to start from the proximal end and progress to the distal area. The bandage should be wrapped for 30 minutes and removed for 15 minutes. p. 1464

A nurse provides postoperative instructions to a patient who underwent reconstructive surgery for an anterior crucial ligament (ACL) injury. Which statement made by the patient indicates the need for further teaching?

"It is not likely that my physical functioning will ever return to normal." Reconstructive therapy involves the removal of a torn anterior cruciate ligament tissue and its replacement with an allograft tissue. The patient's physical functioning may return to normal in six to eight months. ROM exercises are encouraged soon after the surgery to prevent complications related to prolonged immobilization. The knee is placed in a brace or immobilized after surgery. Progressive weight-bearing is determined by the degree of surgical repair. pp. 1467-1468

Which statement indicates specific postoperative care for a patient who underwent finger joint arthroplasty?

"The operated extremity should have a bulky dressing and must be elevated." During the postoperative care of the finger joint, the extremity is kept elevated with bulky dressing to increase venous pressure. The operated extremity should be elevated above heart level to prevent edema formation. Assessment of neurovascular changes in both the upper extremities is to compare both the extremities. This is done to obtain accurate assessment of the operated extremity is general postoperative care followed after an orthopedic surgery. The patient is advised to perform hand exercises for at least 10 to 12 weeks after discharge. p. 1491

Which statement given by the nurse is true about the removal of degenerated menisci from a joint?

"The surgical procedure does not require hospitalization." Debridement is the removal of degenerative debris such as loose bodies, osteophytes, joint debris, and degenerated menisci from a joint. This surgical procedure does not require hospitalization. Excessive activity is restricted until 48 hours after the surgical procedure. Passive flexion exercises with a continuous passive motion are recommended during knee arthroplasty. An isometric muscle-strengthening exercise regimen is encouraged within the confines of an immobilization device to reduce muscle atrophy. p. 1491

A registered nurse is teaching the student nurse about hand surgery. Which statement made by the student nurse about the primary outcome of the surgery indicates a need for further teaching?

"To correct the deformity of the hand" Correcting the deformity of the hand is not a primary objective of the hand surgery. The primary objective of a hand surgery is to restore strength. Finger arthroplasty aims to improve the ability of the hand to grasp in order to improve its functional ability. Stability of the hand is restored by hand surgery. p. 1491

The nurse teaches a student nurse about traction. Which statement made by the student nurse reflects effective learning?

"Traction provides immobilization to the fractured joint." Traction is the application of a pulling force to an injured or diseased part of the body or an extremity. Traction is used to immobilize a joint or part of the body in order to promote joint stabilization and prevent soft tissue damage. Traction promotes active and passive exercise in order to prevent muscle spasms, which may further complicate the fracture. Traction helps to increase space in the joint before major joint reconstruction. Traction provides expansion of joint space during arthroscopic procedures. p. 1476

The nurse provides discharge education to a patient who had recently underwent closed reduction therapy for realigning a dislocated hip joint. What instruction is appropriate for the nurse to include in the care plan?

-"Restrict strenuous activities." -"Return to normal activities gradually." -"Perform gentle range-of-motion exercises." The patient who recently underwent closed reduction therapy for realigning the hip dislocation is advised to restrict strenuous activities that strain the joint. The patient should gradually return to the normal activities. The patient should perform gentle ROM exercises to prevent motion limitations of the joint. Antibiotic prophylaxis is appropriate for patients with open fractures and large tissue defects. The application of warm and moist heat is useful in a strain injury. pp. 1464-1465

Which instructions should the nurse include when teaching a patient about endurance exercise?

-"Start at a low level of effort." -"Start with warming up the muscles." -"Gradually progress to a moderate level." Endurance exercise should begin at a low level of effort. Warming up before exercise is a general rule for all the type of exercises. Endurance exercises should progress gradually to a moderate level. The patient should wear shoes while performing endurance exercises. Dietary changes to increase weight are not needed with endurance exercises. p. 1464

A patient experiences inflammation and pain in the muscles, tendons, and nerves of the neck and spine due to repetitive strain injury (RSI). What ergonomic instructions should the nurse provide to the patient?

-"Take hourly stretch breaks while working at your desk." -"Keep your hips and knees flexed to 90 degrees with the feet flat while sitting." -"Keep your wrist straight when typing and keep the top of the computer monitor level with your forehead." Ergonomic considerations for patients include taking hourly stretch breaks, keeping the hips and knees flexed at 90 degrees, keeping the feet flat on the floor to reduce strain on the soft tissue, keeping the wrist straight when typing, and keeping the top of the computer monitor even with the forehead to reduce strain of muscles and ligaments. Strengthening and conditioning exercises may reduce sprain and strain risk. Warm, moist heat application is used to help patients with a sprain after 48 hours of injury. p. 1465

A nurse is examining a patient who is in a body jacket brace. The patient states that the brace is applied too tightly. What findings in the patient may indicate that the brace is too tightly applied?

-Abdominal pain -Nausea and vomiting -Increased abdominal pressure After application of the body jacket brace, it is important to assess the patient for the development of superior mesenteric artery syndrome (cast syndrome). This condition occurs if the brace is applied too tightly, compressing the superior mesenteric artery against the duodenum. The patient generally complains of abdominal pain, abdominal pressure, nausea, and vomiting. Burning sensations, guarding, and rigidity may not be found in cast syndrome; these symptoms are more prominent if an intraabdominal disorder is present. p. 1472

A patient is admitted to the hospital with an open fracture. What should the nurse do to prevent infection of the fracture wound in this patient?

-Administer prophylactic antibiotics -Administer tetanus and diphtheria prophylaxis It is very important to administer tetanus prophylaxis, diphtheria prophylaxis, and prophylactic antibiotics to a patient with open fractures to prevent any infections. Open fractures are predisposed to be contaminated, and therefore patients are exposed to higher risk of infections. Other measures, including assessing the neurovascular status of the limb; ensuring airway, breathing, and circulation; and immobilizing the affected limb in the position found, are also important, but these activities do not help in preventing infection of the open fracture wound. p. 1478

A patient with a fracture of the right tibia has been advised to use a cane. What instructions should the nurse give to this patient?

-Advance the left leg last. -Advance the right leg first -Hold the cane in the left hand The decision to use assistive devices is made by the health care provider depending on the needs and lifestyle of patient. Use of these devices varies. When a cane is used, the affected limb is advanced along with or after the cane, and the unaffected limb is advanced last. The cane is held in the hand opposite the affected limb. In this case, the right leg is affected, and therefore the cane should be held in the left hand, the right leg should be advanced first, and the left leg should be advanced last. pp. 1477-1478

A nurse is caring for a patient with carpal tunnel syndrome who is advised to undergo surgical repair either by open release surgery or by endoscopic carpal tunnel release surgery. What possible advantages of an endoscopic approach over an open release approach should the nurse explain to the patient?

-An endoscopic approach may allow faster recovery -An endoscopic approach may lead to less postoperative discomfort Carpal tunnel release is recommended in patients whose symptoms last for more than six months. This may be done either by open release or by endoscopic release approaches. However, an endoscopic approach may have the advantages of faster recovery and less postoperative discomfort when compared with open release. The patient should be instructed about wound care and appropriate assessments to be performed at home for both approaches. Both of these techniques can be used in an outpatient setting and under local anesthesia. p. 1466

When treating a patient with compartment syndrome, what measures should the nurse consider to be contraindicated?

-Application of cold compresses -Elevation of the limb above heart level Elevation of the extremity may lower venous pressure and slow arterial perfusion. Therefore the extremity should not be elevated above heart level in case of compartment syndrome. Similarly, the application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome. It may also be necessary to remove or loosen the bandage and split the cast in half (bivalving). A reduction in traction weight may also decrease external circumferential pressures. p. 1479

A patient has been admitted to the hospital for a scheduled knee arthroplasty. What should a nurse do in the preoperative management of this patient?

-Assess muscle strength in the upper limbs -Assess joint function of the upper limbs If lower extremity surgery is planned, the nurse should assess upper extremity muscle strength and joint function to determine the type of assistive devices needed postoperatively for ambulation and activities of daily living. Therefore in this case, the assessment of muscle strength and joint function of the upper limbs is required. Assessment of pain sensation is not important. p. 1492

A nurse is caring for a patient with reported fracture of the tibia. A plaster cast has been applied to the patient. What interventions are important for the care of the cast during the drying period and immediately thereafter?

-Avoid direct pressure on the cast -Handle the cast gently with an open palm -Place several strips of tape over the rough edges Avoid direct pressure on the cast during the drying period. Handle the cast gently with an open palm to avoid denting the cast. The health care provider should place several strips (petals) of tape over the rough areas to ensure a smooth cast edge. A fresh plaster cast should never be covered, because covering it prevents air from circulating; this lack of air circulation allows heat to build up in the cast (which may cause a burn) and may also result in a delay in drying. After drying, the edges may need to be petaled to avoid skin irritation from rough edges and to prevent plaster of Paris debris from falling into the cast and causing irritation or pressure necrosis. p. 1472

The nurse is teaching a group of elderly patients about techniques for preventing musculoskeletal problems. The nurse prioritizes which teaching points for these patients?

-Avoid excessive weight gain -Remove throw rugs in the home -Change positions and rise to standing slowly Throw rugs in the home can create an unsafe environment for ambulation, causing potential falls, so the patient should remove them. It is important to change positions slowly to prevent dizziness that could cause the patient to faint or fall. Excessive weight gain can contribute to osteoarthritis and bone injury. Weight-bearing exercise is encouraged to strengthen the bones, rather than non-weight bearing exercise. The use of ramps would be preferred over steps to prevent falls. p. 1463

A patient is brought to the emergency department after an accident with injury to the right leg. A radiograph of the right femur shows a fracture. What should the nurse note during the peripheral vascular assessment?

-Color -Edema -Capillary refill In cases related to fractures, peripheral vascular assessment should be done. This consists of assessment of color, temperature, capillary refill, peripheral pulses, and edema. Assessment of motor function and pain is included in the peripheral neurologic assessment. pp. 1474-1475

A nurse is taking care of a patient with a cast on the right leg maintained in external traction. However, during the routine examination, the nurse finds that the patient has compartment syndrome. What measures should a nurse take in the management of this patient?

-Cut the cast in half -Reduce external traction weight -Remove or loosen any bandage If the patient has compartment syndrome, the cast should be split in half. If there are any bandages, they should be removed or loosened to remove the pressure. A reduction in traction weight may also decrease external circumferential pressures. Elevation of the extremity may lower venous pressure and slow arterial perfusion. Therefore the extremity should not be elevated above heart level. The application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome. p. 1479

A patient is suspected of having fat emboli after a fractured hip. What assessment data gathered by the nurse are indicative of this condition?

-Decreased platelet count -Prolonged prothrombin time -Pulmonary infiltration on chest radiograph This patient's signs and symptoms indicate that the patient has a condition called acute respiratory distress syndrome, caused by fat emboli. Petechiae located around the neck, the anterior chest wall, the axillae, the buccal membrane, and the conjunctivae of the eyes helps distinguish fat emboli from other problems. Results of blood tests show decreased platelet count and prolonged prothrombin time. A chest radiograph may reveal areas of pulmonary infiltrate or multiple areas of consolidation. The partial pressure of arterial oxygen (PaO 2) and hematocrit are decreased. p. 1480

The patient had a lumbar spine arthrodesis. What should the nurse include in discharge teaching?

-Do not smoke cigarettes -Do not bend your spine until your follow-up appointment After a spinal fusion, the patient should not smoke cigarettes, because nonunion tends to occur more often with smokers. Preventing pressure by not bending or twisting the spine or lifting more than 10 pounds will facilitate healing over time. The amount of time that is needed will be determined by the health care provider at follow-up appointments, but healing usually takes six to nine months. An important aspect of healing is progressively increasing walking, which increases circulation of nutrients and oxygen for healing. If a brace is prescribed to protect the surgical area, the health care provider will prescribe how often the patient should wear it. Driving is not done until the health care provider allows it and the patient is no longer taking opioids for pain. pp. 1485-1486

A patient admitted with Parkinson's disease fell down the stairs in the hospital. The patient is conscious and states there is severe pain in the calf muscles. What should be the immediate course of action for the nurse?

-Elevate the affected limb -Apply ice to the painful area If an injury occurs, the immediate care focuses on applying ice compresses to the injured area to reduce pain, muscle spasms, inflammation, and edema. The affected limb should be elevated to mobilize excess fluid from the area and prevent further edema. The nurse should instruct the patient to limit movements of the affected limb. After the acute phase (usually 24 to 48 hours) moist heat may be applied to the affected area to reduce swelling and provide comfort. Restraining the patient to the bed is not related to the management of this injury. p. 1464

The nurse is caring for a patient with a fractured femur. Which nursing action(s) by the nurse is the priority?

-Elevating the extremity -Providing analgesia as necessary -Compressing the involved extremity -Applying ice compresses to the injured area -Stopping the activity and limiting movement There are five interventions performed for an acute injury. Stopping the activity and limiting movement, applying ice compresses to the injured area, compressing the involved extremity, elevating the extremity, and providing analgesia as necessary. Resting the extremity is not included in the immediate care. p. 1485

What instructions should be given to a patient with a cast to prevent edema and skin breakdown?

-Exercise joints above and below the cast -Apply ice on the fracture site during the first 24 hours -Elevate the affected limb above heart level during the first 48 hours Regardless of the type of cast material, a cast can interfere with circulation and nerve function if edema occurs after the application of the cast. Therefore it is important to teach the patient and caregivers about measures to prevent edema. Elevating the limb above heart level and applying ice in the initial phase (24 to 48 hours) help in preventing edema. The patient should also be encouraged to exercise the joints above and below the cast. Pulling out the cast padding, inserting foreign objects into the cast to scratch an itch, and covering the cast with plastic may predispose patients to skin breakdown and infections. Therefore they should be advised to abstain from doing such things. pp. 1472-1473

A nurse is caring for a patient with a fractured femur. The health care provider finds that the patient has fat embolism syndrome. What treatment (or treatments) of fat embolism syndrome should the nurse anticipate for this patient?

-Fluid resuscitation -Correction of acidosis -Fracture immobilization The treatment of fat embolism syndrome is directed toward the management of symptoms. This includes fluid resuscitation to prevent hypovolemic shock, correction of acidosis, and fracture immobilization. The patient should be encouraged to cough and perform deep breathing. The patient should be repositioned as little as possible to prevent dislodgment of fat droplets into the general circulation. p. 1480

A nurse is attending a patient who has sustained a fracture of the femur. What interventions should the nurse perform to ensure a healthy diet for optimal healing of the injured tissues?

-Include 1g/kg of protein daily -Include foods rich in vitamins C and D -Increase calcium-rich foods in the diet Proper nutrition is an essential component of the healing process in injured tissue. An adequate energy source is needed to promote muscle strength and tone, build endurance, and provide energy for ambulation and maintaining a proper gait. The patient's dietary requirements must include adequate protein, usually 1 g/kg of body weight. The calcium intake should be increased, because immobility and bone healing increase calcium needs. Intake of vitamins C and D should be increased, because these are necessary for optimal soft tissue and bone healing. Magnesium and phosphorus are also necessary for the healing process, and their intake should be increased. B vitamins also aid in the healing of soft tissues and bones. p. 1474

A patient with a fracture of the femur is to be placed in Buck's traction. How should the nurse explain the functions of Buck's traction to the patient?

-It immobilizes the fracture -It reduces muscle spasms -It prevents hip flexion contractures Traction is the application of a pulling force to an injured or diseased part of the body, often an extremity. A Buck's traction boot is a type of skin traction used to immobilize the fracture, prevent hip flexion contractures, and reduce muscle spasms. The traction does not reduce edema or directly help in union of the fractured bone. However, it indirectly helps the process of union of the fractured bone by keeping the limb aligned and reducing spasms and contractures. p. 1470

A patient will undergo debridement of the shoulder joint. After the nurse explains the procedure, the patient asks the nurse what will be removed from the joint. How should the nurse answer?

-Joint debris -Osteophytes -Degenerated menisci The procedure of debridement involves removing from a joint any devitalized tissue, such as loose bodies, joint debris, degenerated menisci, and osteophytes. This procedure is usually performed on the knee or the shoulder using a fiber optic arthroscope. Removal of synovial membrane is called synovectomy. The removal of a wedge of bone is called osteotomy. p. 1491

Which discharge instructions would a nurse give to a patient with a cast?

-Keep the extremity elevated as much as possible -Report a fever or a foul odor coming from beneath the cast A fever or a foul odor coming from beneath the cast may indicate an infection and requires immediate attention. The extremity should be elevated as much as possible to prevent edema. No product such as talcum powder, cornstarch, or lotion should be put down a cast to relieve itching, because this may increase the risk of infection. If pain is present, the patient should take pain medication before reaching an unbearable level. Itching under the cast is normal and does not need to be reported to the primary health care provider, but the patient must be advised to avoid scratching, because breaks in the skin under the cast can easily become infected. Keeping the extremity elevated, not dependent, decreases edema. p. 1477

The nurse is caring for the patient with skeletal traction for an extremity fracture. What action(s) by the nurse are most appropriate?

-Keep the weights off of the floor -Elevate the end of the bed as needed -Make sure that the traction ranges from 5 to 45 pounds (2.3 to 20.4 kg) The weights must be kept off of the floor. The end of the bed may need to be elevated so that the weights are off the floor for traction to be applied. Traction weight ranges from 5 to 45 pounds (2.3 to 20.4 kg). Weight forces have to be in the opposite direction (counter traction). Traction must be applied continuously to be effective and the weights have to move freely through the pulleys. p. 1471

The nurse reviews the test results of a patient that reports shoulder weakness with decreased range-of-motion (ROM). What activities may have contributed to the patient's condition?

-Lifting heavy weights -A blow to the upper arm -Falling onto an outstretched arm The positive results of the drop arm test and a tear seen in the MRI scan may indicate a rotator cuff injury. A tear in the rotator cuff may occur due to repeated overhead motions and can include heavy weight lifting, a blow to the upper arm, or falling onto an outstretched arm. The other activities such as working with vibrating power tools or using a computer keyboard and mouse frequently are not likely to cause a rotator cuff injury. p. 1466

A patient with a hip fracture has been treated with insertion of a prosthesis. What findings indicate dislocation of this prosthesis?

-Limb shortening -A lump in the buttock -External rotation of the limb Symptoms such as sudden severe pain, a lump in the buttock, limb shortening, and external rotation indicate prosthesis dislocation. This requires a closed reduction with conscious sedation or open reduction to realign the femoral head in the acetabulum. Edema of the limb and a weak pulse can be due to other causes, such as compartment syndrome. p. 1484

After a motor vehicle crash, a patient has a dislocated right hip joint, and the bone is exposed in the right thigh. What type of fracture should the nurse document?

-Open -Displaced -Comminuted In this case, the bone is exposed, and therefore it is an open fracture. Comminuted fractures have two or more fragments of bones. Fractures can be classified as displaced or nondisplaced. In a displaced fracture, the two ends of the broken bone are separated from one another and are out of their normal positions. This fracture is not a closed one, because the fractured bone is exposed through soft tissue injury. Greenstick fracture is a type of fracture in which the periosteum is intact across the fracture and the bone is still in alignment. p. 1468

While examining a patient with an injury to the distal humerus, the nurse suspects that the patient has compartment syndrome. What findings in the patient could have raised this suspicion?

-Paralysis of the arm -Pain unrelieved by opioids -Absence of the peripheral pulse Compartment syndrome may occur initially from the body's physiologic response to the injury, or it may be delayed for several days after the injury. The usual signs include weakness and paralysis of the arm, absence of peripheral pulses, and pain that is not relieved by opioids. These signs are due to decreased compartment size resulting from an injury. The resultant pressure may compromise the function of blood vessels, nerves, or tendons that run through that compartment. Pyrexia indicates infection, but it is not a sign that suggests compartment syndrome. Redness and warmth may not be present; instead, the skin may be pale and cold to the touch. p. 1479

A nurse is completing the discharge sheet for a patient with hip fracture, who has been treated by insertion of a prosthesis using a posterior approach. What instructions should be given to this patient before discharge?

-Place a chair inside the tub and remain seated while washing -Inform the dentist about the prosthesis before any dental work -Keep the hip in a neutral, straight position when sitting or lying For a patient who had a hip fracture and has been treated by insertion of a prosthesis using a posterior approach, it is important to teach him or her and the caregiver about the measures to prevent dislocation. Certain measures, such as placing a chair in the tub and remaining seated while washing and keeping the hip in a neutral and straight position when sitting, lying, or walking prevents dislocation. The patient should be advised to inform his or her dentist about the prosthesis before any dental work, so that prophylactic antibiotics can be given if indicated. Many positions and daily activities predispose the patient to the dislocation of the prosthesis. Some of these activities include putting on one's own shoes and socks without using adaptive devices; crossing the legs or feet while seated; assuming the side-lying position incorrectly; standing up or sitting down while the body is flexed more than 90 degrees relative to the chair; and sitting on low seats, especially low toilet seats. It is also important to sit in chairs with arms, because these help the patient to rise to a standing position. pp. 1483-1484

A patient fell from a 20-foot height onto the right elbow. The radiograph revealed a fracture in the middle third of the right humerus, with sharp edges. What are the structures that may be at risk of damage due to the sharp edges of broken bone in this patient?

-Radial nerve -Brachial artery The radial nerve is present in the axillary groove of the humerus, and the brachial artery is located on the anterior aspect of the humerus. Therefore the radial nerve and brachial artery are likely to be damaged by the sharp edges of fractured bone margins of the humerus. The axillary nerve and brachial plexus are present in the axilla. Therefore they are unlikely to be damaged. The ulnar nerve is usually unaffected by bone fractures, owing to the presence of muscles and soft tissues. p. 1475

A nurse has applied Buck's traction to a patient who has sustained a fractured femur. What are the main purposes of this type of traction?

-Reduce muscle spasms -Immobilize and stabilize the fracture Buck's traction, a type of skin traction, is used to stabilize and immobilize a fractured femur. This type of traction decreases the risk for further injury until surgery can be performed and can also ease painful muscle spasms. Secondarily, Buck's traction may reduce the risk of a fat embolism. Buck's traction may be used long-term until the patient is able to undergo surgery, but this is not the preferred treatment. Once muscle spasms have been relieved after the application of Buck's traction, the patient may require less pain medication. Buck's traction does not necessarily allow the nursing staff to care for the patient more easily. p. 1470

A patient experiences a compound fracture. What assessment findings does the nurse expect?

-Soft tissue injury -The skin is broken, exposing the bone In compound fractures, the soft tissue is injured, and the skin is broken, exposing the bone. In nondisplaced greenstick fractures, an incomplete fracture occurs, in which the bone is splintered on one side and bent on the other side. The skin is not broken and remains intact in simple fractures. p. 1468

A patient with a fracture of the humerus is advised to have a cast made of synthetic material. How should the nurse explain the benefits of casts made of synthetic materials, compared with plaster casts?

-Synthetic casts are stronger -Synthetic casts provide for early weight bearing -Synthetic casts can be easily molded to fit the torso or extremity Casts made of synthetic materials are being used more than plaster casts because they are stronger and provide for early weight bearing. The synthetic casting materials (thermolabile plastic, thermoplastic resins, polyurethane, and fiberglass) are activated by submersion in cool or tepid water. Then they are molded to fit the torso or extremity. Synthetic casts are not heavy—in fact, they are lightweight and they are water-resistant. p. 1472

The nurse assesses a patient in the preoperative holding area before total hip arthroplasty (THA). The nurse discusses the expected hospital course with the patient and family. Which are important points to discuss with the patient and family before surgery?

-The presence of any skin infections -Ensuring the procurement of home services -Pain tolerance and management preferences -Previous medical diagnoses and complications Preoperative management of the THA patient focuses on minimizing postoperative complications. Home care services should be discussed preoperatively in order to be in place at the time of discharge. The nurse will discuss prior medical diagnoses and complications such as venous thromboembolism to prevent this postoperatively. Pain is a large part of any postoperative treatment plan and discussing preferences preoperatively may facilitate improved pain control postoperatively. Patients undergoing surgery should be free of any infection or inflammation, so it is important to note any skin infections anywhere on the body. Patients receiving Coumadin or other anticoagulation therapy usually restart anticoagulation postoperatively, although dosing strategies differ depending on the anticoagulant. This patient would not have taken Coumadin prior to the surgery to reduce the risk for hemorrhage. p. 1492

A patient fell on the right elbow and states he or she has severe pain. The nurse suspects fracture of the humerus. During neurologic examination of the patient, which nerves should the nurse assess?

-Ulnar nerve -Median nerve -Radial nerves It is important to evaluate sensory and motor functions of the ulnar, median, and radial nerves in cases of upper extremity injury. Assess neurovascular status by abduction and adduction of the fingers, opposition of the fingers, and supination and pronation of the hand. The tibial and peroneal nerves are assessed if there is any injury to the lower limbs. p. 1481

During the discharge of an older adult patient who has had a history of repeated falls at home, what instructions should a nurse give to the patient to prevent falls?

-Use a walker or cane -Exercise fingers and toes -Avoid walking on uneven surfaces It is very important to teach older patients about the correct measures to prevent falls. Some of these include using a walker or cane while walking and avoiding walking on uneven surfaces. It is also important to develop hobbies, such as needlework or jigsaw puzzles that help to exercise the fingers, and to exercise the toes, thus preventing stiffness. Using ramps in buildings and on street corners, instead of steps, can decrease the risk of falling. Weight-bearing exercises should be performed, because they are important to maintain the strength of the bones and joints. p. 1475

A patient is admitted to the orthopedic surgical unit for a fracture of the left tibia. What instructions should a nurse give concerning the prevention of venous thromboembolism?

-Wear compression gradient stockings -Exercise toes of the left lower limb against resistance -Perform range-of-motion exercises on the right lower limb There is a high risk of venous thromboembolism in the orthopedic surgical patient. Therefore measures should be taken by the attending nurse to prevent it. These measures include instructing the patient to wear compression gradient stockings (antiembolism hose) and to use sequential compression devices. The patient should also be encouraged to move (dorsiflex and plantar flex) the fingers or toes of the affected extremity against resistance and perform range-of-motion exercises on the unaffected lower extremities. p. 1480

The registered nurse is teaching the student nurse about the common sites for synovectomy. Which understanding about the surgical site by the student nurse indicates effective learning?

-Wrist joint -Finger joint -Elbow joint Common sites for a synovectomy are the wrist, fingers, and elbow joints. Synovectomy is performed to relieve pain and improve range of motion. The hip and knee joints are not common sites for synovectomy. Hip arthroplasty and hip resurfacing are usually performed at the hip joint. Knee arthroplasty is performed at the knee joint to replace the knee joint and chronic knee pain can be relieved with an osteotomy. p. 1490

The nurse teaches an older adult about ways to prevent musculoskeletal problems. What instructions are appropriate for the nurse to include in the patient's education?

1. "Perform tai chi exercises." 2. "Eliminate scatter rugs at home." 3. "Discuss the use of medications for pain." Older adults may be advised to learn tai chi because it provides range of motion exercises. Scatter rugs should be eliminated at home to decrease the risk of falling. The use of medications should be discussed for pain relief due to osteoarthritis. Weight bearing exercises are recommended to reduce musculoskeletal problems. Model building and jigsaw puzzles activities help in exercising finger joints and prevent stiffness. p. 1463

Which surgery is considered to be the most appropriate in a patient with osteoarthritis and complete loss of function in the knee joint?

Arthroplasty A patient with osteoarthritis with a complete loss of function in the knee joint needs an arthroplasty to replace the joint. Osteotomy is a surgical procedure in which a part of the bone is sliced to change alignment, correcting deformity and relieving chronic pain. Arthrodesis is the surgical fusion of a joint and is performed only when the joint is severely infected or if reconstructive surgery fails. Synovectomy is used as a prophylactic measure and as a palliative treatment for rheumatoid arthritis (RA) p. 1491

What is a key benefit associated with strengthening exercises?

Building of bone density Strengthening exercises that involve working against resistance help to build bone density. Balancing exercises may help in prevention of falls. Pain reduction is not associated with these exercises. Strength exercises do not cure or treat infections. p. 1475

Which condition does the nurse anticipate if a patient experiences a severe injury to the ligament around the humerus bone?

Dislocation Severe injury of the ligamentous structures surrounding the humerus is a dislocation. A strain is an excessive stretching of the muscle, its fascial sheath, or a tendon. A sprain generally represents an injury to the ligamentous structures surrounding a joint. Subluxation is a partial displacement of the joint surface. pp. 1464-1465

The nurse plans care for a patient who has a fractured femur. During the 48 to 72 hours after the fracture the nurse should monitor the patient for the development of what?

Fat emboli Pressure on the bone marrow or an increase in catecholamines (related to stress) can mobilize fatty acids and the development of fat globules in the bloodstream. These fat globules travel to the lung and become lodged, causing the pulmonary symptoms. Renal calculi, muscle atrophy, and bone demineralization are potential complications of immobility; however, they would develop much later than 72 hours after the fracture. p. 1480

A patient experiences a nondisplaced fracture. What condition can potentially displace the fracture in the patient?

Muscle spasm Muscle spasms may displace previously nondisplaced fractures. Crepitation may increase the chance of nonunion of the bones. Ecchymosis is discoloration of the skin that may appear immediately after the injury and distal to the injury. Edema and swelling indicate occluded circulation. p. 1469

The nurse is caring for a patient with a fracture who has a Buck's traction boot in place. Which complication is prevented by the use of the boot?

Muscle spasms Traction devices apply a pulling force on a fractured extremity in order to realign the bone. A Buck's traction boot is a type of skin traction used to immobilize a fracture, prevent hip flexion contractures, and reduce muscle spasms. Continuous passive motions (CPM) decrease the incidence of posttraumatic arthritis. CPM is used for various joints, such as the knee and shoulder, to prevent intraarticular and extraarticular adhesions. p. 1470

What is the duration of hospitalization for hip arthroplasty?

Three to five days The duration of a hospital stay after hip arthroplasty is three to five days, depending on the patient's course and need for physical therapy. The patient would not recover in one or two days. Two to four weeks or six to twelve weeks of hospitalization would be unnecessary. p. 1492

Which condition can be prevented with anticoagulant drugs in a patient who underwent orthopedic surgery?

Thromboembolism Thromboembolism can be prevented with anticoagulant drugs. These drugs diminish hypercoagulability. Antibiotics reduce bone infection. Corticosteroids treat fat embolism. Proper management techniques and surgery can relieve compartment syndrome. p. 1492

Which body part of the patient is at risk for superior mesenteric artery syndrome when sustaining a fracture?

Vertebrae In stable spine injuries, a thoracic or lumbar spine body jacket brace is used for immobilization and support. Superior mesenteric artery syndrome occurs if the brace is applied too tightly, compressing the superior mesenteric artery against the duodenum. Knee injuries, lower extremity injuries, and upper extremity injuries do not require a thoracic or lumbar spine body jacket brace and, therefore, are not associated with mesenteric artery syndrome. p. 1472

The nurse is caring for a patient who underwent left total knee arthroplasty and has a new prescription to be "up in the chair today before noon." What action should the nurse take to protect the knee joint while carrying out the prescription?

Put on a knee immobilizer before moving the patient in and out of bed and keep the surgical leg elevated while sitting The nurse should apply a knee immobilizer for stability before assisting the patient to get out of bed. This is a standard measure to protect the knee during movement following surgery. Although an analgesic should be given before the patient gets up in the chair for the first time, it will not protect the knee joint. Full weight bearing is begun before discharge, so a walker will not be used if the patient did not need one before the surgery. The CPM machine is not kept in place while the patient is getting up to the chair. p. 1491

A newborn baby has sustained an uncomplicated midshaft fracture of the femur. In how many weeks will the fracture heal? Record your answer as a whole number.

3 weeks Many factors influence fracture healing, including displacement, the site of the fracture, the blood supply to the area, and any immobilization and internal fixation devices (e.g., screws, pins). Healing time for fractures increases with age. An uncomplicated midshaft fracture of the femur heals in 3 weeks in a newborn and in 20 weeks in an adult. p. 1470

Which postoperative care, given by the nurse to the patient after a total hip replacement surgery, indicates an effective intervention?

Allowing the patient to use a pillow between the legs for the first six weeks after surgery The nurse should allow the patient to use a pillow between the legs for the first six weeks after surgery. It should be used when lying on the nonoperative side or when in a supine position to maintain the joint in abduction and prevent dislocation of the new joint. Sitting on chairs without arms will lead to a sudden flexing of the body more than 90°, resulting in destabilization of the prosthesis. Crossing of the legs at the knees or ankles affects healing of the soft tissue of the hip joint, leading to predisposition of the joint. Performing daily activities such as putting on shoes and socks that require flexing the body more than 90 °, will lead to damage of the soft tissue. Therefore, it should be avoided till at least six weeks after the surgery. p. 1492

Which postoperative care should be included in the nursing care plan of a patient who had surgery on the wrist?

An occupational therapist assisting the patient to perform hand exercises The success of any surgery depends largely on the postoperative treatment plan, usually implemented by an occupational therapist. After wrist surgery, hand exercises would be suggested at least three or four times a day for 10 to 12 weeks under the guidance of an occupational therapist. Postoperative care that focuses on patient communication and adequate nutrition would be important for facial fractures. Passive and active exercises performed by the patient help to maintain the strength of the affected extremity; however, they are not specific to postoperative care. Pain management techniques include epidural or intrathecal analgesia. These are common interventions during any joint surgery. p. 1492

Which condition in a patient indicates that he or she is an ideal candidate for an osteotomy?

Ankylosing spondylitis An osteotomy involves removing a wedge or slice of bone to change alignment and to shift weight bearing, correcting a deformity. A patient with ankylosing spondylitis may benefit the most from an osteotomy, because it corrects the deformity in the patient. Synovitis is the inflammation of the synovial membrane and is corrected through synovectomy. Osteoarthritis and rheumatoid arthritis are inflammatory disorders and are not treated with osteotomy. p. 1491

What is the most useful initial nursing action for a patient who sustains a joint sprain?

Applying ice compresses to the injured area Ice application is the most useful intervention after a sprain. Cold compression produces hypothermia of the affected area, facilitating vasoconstriction and reducing the perception and transmission of nerve pain impulses. Antibiotic prophylaxis is administered for an open fracture or external extremity injury. Analgesics such as aspirin can be administered after the cold compress. Patient instructions should be provided after the extent of the injury is determined and initial interventions performed. p. 1464

The patient had frostbite on the distal areas of the toes on both feet. The patient is scheduled for amputation of the damaged tissue. Which assessment finding or diagnostic study is the most objective indicator for locating the level of the patient's injury?

Arteriography showing blood vessels Arteriography is the most objective study to determine viable tissue for salvage based on perfusion, because actual blood flow through the tissues is observed in real time. It is considered the gold standard for evaluating arterial perfusion. Bilateral peripheral pulse assessment; areas of black, indurated, and cold tissue; and bilateral pale and cool skin all identify the lack of tissue perfusion, but not the specific area where tissue perfusion stops and amputation needs to occur. p. 1487

What are the closed sacs lined with synovial membrane that contain a small amount of synovial fluid that are located at sites of friction in the joints?

Bursae Bursae are the closed sacs lined with synovial membrane containing a small amount of synovial fluid. These are located at sites of friction, such as between tendons and bones, and near the joints. The crescent-shaped pieces of fibrocartilage in the knee, located at the sites of friction are menisci. The rotator cuff is the complex of four shoulder muscles, the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. The tunnel formed by ligaments and bones is the carpal tunnel. p. 1468

A coal miner with a history of rheumatoid arthritis reports pain, swelling, and a limited range of motion in the knee joints. What diagnosis does the nurse suspect?

Bursitis Bursitis is the inflammation of the bursae located near the joints. Rheumatoid arthritis causes inflammation in the joints, resulting in friction between joint surfaces. The repetitive kneeling involved in occupations such as coal mining may result in bursitis. A shin splint is inflammation along the anterior aspect of the calf due to periostitis. A rotator cuff tear is a muscle tear around the shoulder joint. Impingement syndrome is also a shoulder injury. p. 1468

A patient with a leg fracture is scheduled for a fasciotomy. What complication is identified to have caused the need for this type of surgery?

Compartment syndrome Compartment syndrome is characterized by swelling and increased pressure within a limited space, which presses and compromises the function of the blood vessels, nerves, and/or tendons that run through that compartment. Surgical decompression of soft tissue is done through fasciotomy. The occurrence of infection is greatly reduced with antibiotics in conjunction with aggressive surgical management. Fat embolism syndrome treatment includes fluid resuscitation to prevent hypovolemic shock, correction of acidosis, and replacement of blood loss. Venous thromboembolism can be managed with drug management therapy such as anticoagulants. p. 1479

A patient with a long leg cast reports pain in the toes. The nurse discovers that the toes are pale and cool to the touch with intact pulses and minimal neuropathy. The findings indicate that the patient may be experiencing what?

Compartment syndrome Compartment syndrome is the progressive compromise of neurovascular function of tissue in a confined space such as a cast. It may also result from circumferential inflammation around an extremity. The earliest sign is paresthesias, followed by pain, pressure resulting from edema, pallor, paralysis, and absence of pulse. (Absence of the peripheral pulse is a late and ominous sign.) A pressure ulcer is caused by decreased circulation due to pressure, tissue hypoxia, and destruction. Osteomyelitis is an infectious process within the bone. A fat embolism is an acute event in which fat globules released into circulation obstruct pulmonary circulation. It is seen with fractures of long bones such as the femur. p. 1479

The nurse is completing a neurovascular assessment on the patient with a tibial fracture and a cast. The feet are pulseless, pale, and cool. The patient says they are numb. What should the nurse suspect is occurring?

Compartment syndrome The nurse should suspect compartment syndrome with one or more of the following six Ps: paresthesia, pallor, pulselessness, pain distal to the injury and unrelieved with opioids, pressure increases in the compartment, and paralysis. Although paresthesia and poor venous return are evident, these are just some of the manifestations of compartment syndrome. Pitting edema is not evident. p. 1479

While completing an admission history for a patient with osteoarthritis admitted for knee arthroplasty, the nurse asks about the patient's perception of the reason for the admission. The nurse expects the patient to relate which response to this question?

Debilitating joint pain The most common reason for knee arthroplasty is debilitating joint pain despite attempts to manage it with exercise and drug therapy. Recent knee trauma, repeated knee infections, and onset of "frozen" knee joint are not primary indicators for a knee arthroplasty. p. 1490

The nurse reviews the results of a magnetic resonance image (MRI) study that was performed on a patient with a severe shoulder injury. Which MRI finding has the potential risk of dislocation?

Deformation injury to the humerus around the shoulder joint The patient with a dislocation may have deformation injury to the humerus around the shoulder joint. Tearing of ligaments in the shoulder may not indicate a dislocation. Mild tears in the shoulder muscles may not indicate dislocation. Severe tearing in the shoulder muscles may not indicate dislocation. p. 1465

A patient experiences a tearing of a ligament as a result of shearing stresses applied to a joint. What diagnosis does the nurse anticipate?

Ligament injury Ligament injury is the tearing or stretching of a ligament as a result of inversion, eversion, shearing, or torque applied to a joint. Overuse syndrome results from prolonged force or repetitive movements and awkward postures. A tear within the muscle or tendinoligamentous structures around the shoulder is a rotator cuff tear. Impingement syndrome is the entrapment of soft tissue structures under the coracoacromial arch of the shoulder. p. 1463

A patient experiences an unstable wrist fracture. Which type of cast will be most beneficial for the patient?

Long arm cast A patient who has an unstable wrist fracture needs restricted movement of the wrist and elbow that extends to the proximal humerus. This is provided by a long arm cast. Simple fractures and complex fractures with extensive soft tissue damage, nonunion or malunion, and limb lengthening can be done through external fixation, which is often used in an attempt to salvage extremities. By definition, a short arm cast facilitates unrestricted elbow motion, which is harmful for the patient with an unstable wrist fracture. p. 1472

Which assistive device should be included in the plan of care for a patient with tendonitis who has a recurrence of symptoms?

Orthosis Tendonitis may be described as the inflammation of a tendon due to overuse or incorrect use. An orthosis is a protective brace used in the treatment of recurrence of symptoms. Walkers, crutches, and gait belts can aid in walking but do not prevent recurrence of symptoms. p. 1463

A patient with a cast for a fractured radius reports, "My fingers feel numb." Which action is the highest priority for the nurse?

Performing a thorough neurovascular assessment Numbness distal to a casted extremity is an indication of decreased circulation, nerve compression, and possibly compartment syndrome. The nurse should perform a full neurovascular assessment to determine the extent of the problem. After the nurse has performed the assessment, the arm may be elevated on two pillows while the primary health care provider is notified. Numbness in the fingers of the casted arm is not a normal response. pp. 1474-1475