Mod 14 EAQs

The nurse teaches an older adult about ways to prevent musculoskeletal problems. Which instructions are appropriate for the nurse to include in the patient's education? Select all that apply. A. "Perform tai chi exercises." B. "Eliminate scatter rugs at home." C. "Discuss the use of medications for pain." D. "Do not perform weight-bearing exercises on a daily basis." E. "Do not get involved in activities such as model building and jigsaw puzzles."

ANS- A. "Perform tai chi exercises." B. "Eliminate scatter rugs at home." C. "Discuss the use of medications for pain." Rationale: Older adults may be advised to learn tai chi because it is a low impact exercise that provides gentle range of motion. Scatter rugs in the home should be eliminated to decrease the risk of falling. The use of medications for any pain should be discussed so that mobility does not become restricted due to disuse. Weight-bearing exercises are recommended to reduce musculoskeletal problems. Model building and jigsaw puzzle activities help in exercising finger joints and preventing stiffness.

Which patients should the nurse assess for signs and symptoms of osteomyelitis? Select all that apply. A. A 60-year-old diabetic who has a blunt injury B. A 14-year-old old boy who sustained an ankle sprain C. A 50-year-old man who underwent a total hip replacement D. A 20-year-old woman with a closed fracture of the humerus E. A 30-year-old man with a tibia fracture and a deep wound over it

ANS- A. A 60-year-old diabetic who has a blunt injury C. A 50-year-old man who underwent a total hip replacement E. A 30-year-old man with a tibia fracture and a deep wound over it Rationale: Osteomyelitis is the infection of the bone, its marrow, and the soft tissues surrounding it. The 60-year-old patient with diabetes mellitus will have vascular insufficiency and a suboptimal immune system, facilitating the spread of microorganisms, and resulting in osteomyelitis. The 50-year-old man who underwent a total hip replacement can be a potential source of infection. An open fracture with a deep wound may facilitate an easy access for microorganisms to get to the bone, resulting in osteomyelitis. The 14-year old boy who sustained an ankle sprain would not develop osteomyelitis due to having a good immune system and an injury limited to soft tissues. The 20-year-old woman with a closed fracture of the humerus may not develop osteomyelitis due to the closed nature of the injury.

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? Select all that apply. A. Administer prophylactic antibiotics. B. Ensure airway, breathing, and circulation. C. Assess the neurovascular status of the limb. D. Administer tetanus and diphtheria prophylaxis. E. Immobilize the affected extremity in the position found.

ANS- A. Administer prophylactic antibiotics. D. Administer tetanus and diphtheria prophylaxis. Rationale: 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.

When attending a patient who has undergone hip replacement surgery, what interventions should a nurse perform to prevent thromboembolism? Select all that apply. A. Apply compression gradient stockings B. Avoid moving toes of the affected extremities C. Perform range-of-motion exercises on the affected extremity D. Administer low-molecular-weight heparin, such as enoxaparin E. Administer a prophylactic anticoagulant drug, such as warfarin

ANS- A. Apply compression gradient stockings D. Administer low-molecular-weight heparin, such as enoxaparin E. Administer a prophylactic anticoagulant drug, such as warfarin Rationale: Because of the high risk of venous thromboembolism in the orthopedic surgical patient, prophylactic anticoagulant drugs, such as warfarin, or low-molecular-weight heparin, such as enoxaparin, may be prescribed. In addition to wearing compression gradient stockings, the patient should move (dorsiflex and plantar flex) the toes of the affected extremity against resistance and perform range-of-motion exercises on the unaffected lower extremities.

The nurse is admitting a patient to the acute care unit with a history of a herniated lumbar disc and low back pain. In completing a more thorough pain assessment, the nurse should ask the patient if which action aggravates the pain? A. Bending or lifting B. Application of warm moist heat C. Sleeping in a side-lying position D. Sitting in a fully extended recliner

ANS- A. Bending or lifting Rationale: Back pain that is related to a herniated lumbar disc often is aggravated by events and activities that increase the stress and strain on the spine, such as bending or lifting, coughing, sneezing, and lifting the leg with the knee straight (straight leg-raising test). Application of moist heat, sleeping position, and ability to sit in a fully extended recliner do not aggravate the pain of a herniated lumbar disc.

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? Select all that apply. A. Cut the cast in half. B. Reduce external traction weight. C. Remove or loosen any bandage. D. Apply cold compresses to the leg. E. Elevate the affected limb above heart level.

ANS- A. Cut the cast in half. B. Reduce external traction weight. C. Remove or loosen any bandage. Rationale: 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.

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? Select all that apply. A. Fluid resuscitation B. Correction of acidosis C. Avoidance of coughing D. Fracture immobilization E. Frequent change in positions

ANS- A. Fluid resuscitation B. Correction of acidosis D. Fracture immobilization Rationale: 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.

A patient has a mandibular fracture from an accident, and there is prominent swelling around it. What are the important nutritional measures that need to be followed in the postoperative stages? Select all that apply. A. Give prune juice to drink. B. Administer bulk-forming laxatives. C. Include liquid protein supplements. D. Give a low-carbohydrate, high-bulk diet. E. Instruct the patient to chew food properly.

ANS- A. Give prune juice to drink. B. Administer bulk-forming laxatives. C. Include liquid protein supplements. Rationale: Ingestion of sufficient nutrients poses a challenge because the diet must be liquid. The patient easily tires of sucking through a straw or laboriously using a spoon. Liquid protein supplements may be helpful for improving the nutritional status. The low-bulk, high-carbohydrate diet and the intake of air through the straw can create problems related to constipation and flatus. Prune juice and bulk-forming laxatives may help to ward off these problems. The constraint of the diet to only liquids usually results in a low-bulk, high-carbohydrate diet. Chewing is not applicable here, because the diet must be liquid with any form of mandibular immobilization.

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? Select all that apply. A. Include 1g/kg of protein daily. B. Include foods rich in vitamins C and D. C. Increase calcium-rich foods in the diet. D. Decrease the intake of foods rich in B vitamins. E. Decrease magnesium- and phosphorus-rich foods.

ANS- A. Include 1g/kg of protein daily. B. Include foods rich in vitamins C and D. C. Increase calcium-rich foods in the diet. Rationale: 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.

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? Select all that apply. A. It immobilizes the fracture. B. It reduces muscle spasms. C. It reduces injury-related edema. D. It prevents hip flexion contractures. E. It helps in union of the fractured bone.

ANS- A. It immobilizes the fracture. B. It reduces muscle spasms. D. It prevents hip flexion contractures. Rationale: 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.

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? Select all that apply. A. Joint debris B. Osteophytes C. A wedge of bone D. Synovial membrane E. Degenerated menisci

ANS- A. Joint debris B. Osteophytes E. Degenerated menisci Rationale: 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.

The nurse is caring for the patient with skeletal traction for an extremity fracture. What action(s) by the nurse are most appropriate? Select all that apply. A. Keep the weights off of the floor. B. Elevate the end of the bed as needed. C. Ensure that the weights are secured to the pulleys. D. Confirm that the forces are pulling in the same direction. E. Make sure that the traction ranges from 5 to 45 pounds (2.3 to 20.4 kg). F. Apply the traction intermittently as prescribed by the health care provider (HCP)

ANS- A. Keep the weights off of the floor. B. Elevate the end of the bed as needed. E. E. Make sure that the traction ranges from 5 to 45 pounds (2.3 to 20.4 kg). Rationale: 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.

The nurse is giving the patient gentamicin through a central line. What actions by the nurse are appropriate? Select all that apply. A. Monitor peak and trough levels B. Obtain daily blood cultures during therapy. C. Evaluate renal function before starting therapy. D. Assess patient for dehydration before starting therapy. E. Obtain electrocardiogram (ECG) before initiating therapy. F. Teach patient to contact the health care provider (HCP) if any visual, hearing, or urinary problems occur.

ANS- A. Monitor peak and trough levels C. Evaluate renal function before starting therapy. D. Assess patient for dehydration before starting therapy. F. Teach patient to contact the health care provider (HCP) if any visual, hearing, or urinary problems occur. Rationale: Renal function must be evaluated and any sign of dehydration needs to be determined before starting therapy. While on gentamicin, peak and trough levels have to be performed at regular intervals to prevent any renal or inner ear problems. The patient has to be instructed to contact the HCP if any visual, hearing, or urinary problems occur. Blood cultures need to be done before therapy is begun but not after it's started. An ECG is not necessary before starting the drug.

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? Select all that apply. A. Open B. Closed C. Displaced D. Greenstick E. Comminuted

ANS- A. Open C. Displaced E. Comminuted Rationale: 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.

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? A. Progressive leg exercises to obtain 90-degree flexion B. Early ambulation with full weight bearing on the left leg C. Bed rest for three days with the left leg immobilized in extension. D. Immobilization of the left knee in 30-degree flexion for two weeks to prevent dislocation

ANS- A. Progressive leg exercises to obtain 90-degree flexion. Rationale: 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.

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? Select all that apply. A. Reduce muscle spasms B. Reduce the risk of a fat embolism C. Repair the fracture without surgery D. Immobilize and stabilize the fracture E. Reduce the amount of analgesics required F. Allow the nursing staff to care for the pateint more easily

ANS- A. Reduce muscle spasms D. Immobilize and stabilize the fracture Rationale: 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.

Which drug is monitored via measurement of prothrombin time in patients who undergo orthopedic surgeries? A. Warfarin B. Enoxaparin C. Rivaroxaban D. Fondaparinux

ANS- A. Warfarin Rationale: 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.

A patient with a nonunion of the tibia receives repair via an external fixation. What signs in the patient may indicate infection around the fixator pins? Select all that apply. A. pain at the pin site B. Exudate from the pin site C. Pin looseness D. Edema around the pin E. Pale skin around the pin

ANS- A. pain at the pin site B. Exudate from the pin site D. Edema around the pin Rationale: External fixation is often used as an attempt to salvage extremities that otherwise might require amputation. Because the use of an external device is a long-term process, ongoing assessment for pin loosening and infection is critical. Infection is indicated by the presence of pain, exudates, and edema around the pin site. Pin looseness does not indicate infection. In the presence of infection, the skin around the pin site is red (erythematous), not pale.

An injured soldier had an amputation of the left leg and is reporting shooting pain and heaviness in the area of the missing leg. What would be the best response by the nurse for this patient? A. Use mirror therapy B. Give opioid analgesics C. Rebandage the residual limb D. Show the patient that the leg is gone

ANS- A. use mirror therapy Rationale: Mirror therapy has been shown to reduce phantom limb pain in some patients. Opioid analgesics, rebandaging the residual limb, and showing the patient that the leg is gone will not decrease phantom limb pain.

A patient with acute osteomyelitis asks the nurse how this problem will be treated. Which response by the nurse is most appropriate? A. "Oral antibiotics often are required for several months." B. "Intravenous (IV) antibiotics usually are required for several weeks." C. "Surgery almost always is necessary to remove the dead tissue that is likely to be present." D. "Drainage of the foot and instillation of antibiotics into the affected area is the usual therapy."

ANS- B. "Intravenous (IV) antibiotics usually are required for several weeks." Rationale: The standard treatment for acute osteomyelitis consists of several weeks of IV antibiotic therapy. This is because bone is denser and less vascular than other tissues, and it takes time for the antibiotic therapy to eradicate all of the microorganisms. Oral antibiotics are not effective. Surgery may be used for chronic osteomyelitis, which may include debridement of the devitalized and infected tissue and irrigation of the affected bone with antibiotics. Antibiotics are not commonly injected into the affected area.

The nurse teaches a student nurse about traction. Which statement made by the student nurse reflects effective learning? A. "Traction prevents active and passive exercise." B. "Traction provides immobilization to the joint or body part." C. "Traction decreases the joint space before a major joint reconstruction." D. "A Buck's traction boot is a type of skeletal traction."

ANS- B. "Traction provides immobilization to the joint or body part." Rationale: 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. It does not prevent it. This minimizes muscle spasms, which may further complicate the injury. Traction helps to increase, not decrease, space in the joint before major joint reconstruction. A Buck's traction boot is s type of skin traction that is used preoperatively in a patient with a hip fracture awaiting surgery. It helps to reduce muscle spasm.

A patient is at risk for developing a deep vein thrombosis after a knee replacement surgery. Which interventions would reduce the risk of this complication? Select all that apply. A. Applying heat to the operative site B. Administrating prophylactic anticoagulant drugs C. Administrating intermittent positive pressure ventilation D. Restricting the range of motion of the unaffected lower extremity E. Encouraging the patient to wear a compression gradient stocking

ANS- B. Administrating prophylactic anticoagulant drugs E. Encouraging the patient to wear a compression gradient stocking Rationale: To decrease the risk for thromboembolism after knee replacement surgery, a patient is treated with prophylactic anticoagulant drugs. Encouraging the patient to wear a compression gradient stocking will lead to increased venous blood return from the extremities. Heat is applied during the initial postoperative period to decrease swelling. However, heat does not affect the development of a deep vein thrombosis. Intermittent positive pressure ventilation is administered during fat embolism syndrome. Restricting the range of motion of the unaffected lower extremity would result in thromboembolism.

A patient is suspected of having fat embolism syndrome (FES) following a traumatic femur fracture. Which assessment data gathered by the nurse supports this suspicion? Select all that apply. A. Increased hematocrit B. Chest pain C. Mental status changes D. Petechiae on the anterior chest wall E. Increased partial pressure of arterial oxygen

ANS- B. Chest pain C. Mental status changes D. Petechiae on the anterior chest wall Rationale: FES is characterized by a classic triad of symptoms, including respiratory changes such as chest pain, dyspnea and cyanosis; mental status changes including restlessness, confusion, and memory loss; and skin changes including petechiae of the neck, anterior chest wall, buccal mucosa, and conjunctiva. In FES, the partial pressure of arterial oxygen (PaO 2) and hematocrit would be decreased, not increased.

Which discharge instructions would a nurse give to a patient with a cast? Select all that apply. A. Use talcum powder under the cast as needed. B. Keep the extremity elevated as much as possible. C. Take pain medications only when the pain is unbearable. D. Report a fever or a foul odor coming from beneath the cast. E. Report itching under the cast that could indicate an infection. F. Keep the extremity in a dependent position as much as possible.

ANS- B. Keep the extremity elevated as much as possible. D. Report a fever or a foul odor coming from beneath the cast. Rationale: 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.

An occupational health nurse is conducting an awareness program to prevent limb amputations. When explaining the risk of amputation, which population group would the nurse indicate as at high risk for amputation? Select all that apply. A. Patients with ulcerative colitis B. Patients with diabetes mellitus C. Patients with myasthenia gravis D. Patients with chronic osteomyelitis E. Patients with peripheral vascular disease

ANS- B. Patients with diabetes mellitus D. Patients with chronic osteomyelitis E. Patients with peripheral vascular disease Rationale- Patients with diabetes mellitus, chronic osteomyelitis, or peripheral vascular disease are predisposed to increased risk of amputation. Controlling these diseases can eliminate or delay the need for amputation. Ulcerative colitis and myasthenia gravis do not lead to gangrene in the limbs or to amputation.

A patient with acute osteomyelitis is prescribed gentamicin. Which clinical parameter in the patient indicates that the prescription needs to be reconsidered? A. Body temperature: 100° F B. Serum creatinine: 3.4 mg/dL C. White blood cell count: 11,000 cells/mcL D. Erythrocyte sedimentation rate (ESR): 20 mm/hr

ANS- B. Serum creatinine: 3.4 mg/dL Rationale: Gentamicin is an aminoglycoside, which is nephrotoxic and is contraindicated in patients with renal dysfunction. A creatinine level of 3.4 mg/dL indicates renal dysfunction and administration of gentamicin may cause further renal damage. A body temperature of 100° F indicates fever, which is a common finding in osteomyelitis. A white blood cell count of 11,000 cells/mcL is above the normal levels and indicates infection. However, it may not be a contraindication for gentamicin administration. The erythrocyte sedimentation rate (ESR) of 20 mm/hr is above the normal range and indicates infection. It is not a contraindication for gentamicin administration.

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? A. Pain at the surgical site B. Sudden shortness of breath C. Serosanguineous wound drainage D. Limited range of motion of the affected leg

ANS- B. Sudden shortness of breath Rationale: 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.

Which body part of the patient is at risk for superior mesenteric artery syndrome when sustaining a fracture? A. Knee B. Vertebrae C. Lower extremity D. Upper extremity

ANS- B. Vertebrae Rationale: 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.

A patient has undergone amputation just below the level of the elbow in the right upper limb. The patient states that there is still the sensation of pain in the missing portion one day after surgery. What should the nurse inform the patient? A. You are having illusions. B. It is normal to feel this way. C. You are having hallucinations. D. You are experiencing delusions.

ANS- B. it is normal to feel this way Rationale: After an amputation, the patient may still feel the presence of the amputated part. The nurse should explain to the patient that it is normal to feel this way. This phenomenon, termed phantom limb sensation, occurs in many amputees. Such a sensation is not illusion, delusion, or hallucination.

What is the duration of hospitalization for hip arthroplasty? A. one to two days B. three to five days C. two to four weeks D. six to twelve weeks

ANS- B. three to five days Rationale: 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.

A patient with osteomyelitis in the left femur has been receiving gentamicin therapy for two weeks. During a follow up visit, which patient statement indicates that the treatment should be discontinued? A. "I don't have a fever now." B. "I have severe pain in my left leg." C. "I have a ringing sensation in my ear." D. "The pus from the wound has stopped draining."

ANS- C. "I have a ringing sensation in my ear." Rationale: A ringing sensation in the ear indicates ototoxicity due to the gentamicin. The treatment should be stopped to prevent worsening of the complication. Absence of fever may indicate that the infection has been reduced, but treatment should not be stopped. Severe pain in the leg is a manifestation of osteomyelitis and does not indicate that the treatment should be stopped. Absence of pus indicates effectiveness of treatment, but does not mean that the treatment should be stopped.

The nurse has reviewed proper body mechanics with a patient with a history of low back pain caused by a herniated lumbar disc. Which statement made by the patient indicates a need for further teaching? A. "I should sleep on my side or back with my hips and knees bent." B. "I should exercise at least 15 minutes every morning and evening." C. "I should pick up items by leaning forward without bending my knees." D. "I should try to keep one foot on a stool whenever I have to stand for a period of time."

ANS- C. "I should pick up items by leaning forward without bending my knees." Rationale: The patient should avoid leaning forward without bending the knees. Bending the knees helps to prevent lower back strain and is part of proper body mechanics when lifting. Sleeping on the side or back with hips and knees bent and standing with a foot on a stool will decrease lower back strain. Exercising 15 minutes twice daily will be done once symptoms subside, and will be aimed at back-strengthening.

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? A. Infection B. Fat embolism syndrome C. Compartment syndrome D. Venous thromboembolism

ANS- C. Compartment syndrome Rationale: 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.

A patient hospitalized with osteomyelitis has a prescription for bed rest with bathroom privileges, with the affected foot elevated on two pillows. The nurse would place highest priority on which intervention? A. Ambulate the patient to the bathroom every two hours. B. Ask the patient about preferred activities to relieve boredom. C. Perform frequent position changes and range-of-motion exercises. D. Allow the patient to dangle legs at the bedside every two to four hours.

ANS- C. Perform frequent position changes and range-of-motion exercises. Rationale: The patient is at risk for atelectasis of the lungs and for contractures because of prescribed bed rest. For this reason, the nurse should place the priority on changing the patient's position frequently to promote lung expansion and performing range-of-motion (ROM) exercises to prevent contractures. Assisting the patient to the bathroom will keep the patient safe, because the patient is in pain, but it may not be needed every two hours. Providing activities to relieve boredom will assist the patient to cope with the bed rest, and dangling the legs every two to four hours may be too painful. The priority is position changes and ROM exercises.

A patient with a cast for a fractured radius reports, "My fingers feel numb." Which action is the highest priority for the nurse? A. Elevating the arm on two pillows B. Notifying the primary health care provider C. Performing a thorough neurovascular assessment D. Reassuring the patient that this is a normal response

ANS- C. Performing a thorough neurovascular assessment Rationale: 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.

The nurse suspects that a patient is experiencing a fat embolism after sustaining a femur fracture. What clinical manifestations does the nurse expect? A. Tachypnea, tachycardia, shortness of breath, and paresthesia B. Paresthesia, bradycardia, bradypnea, petechial rash on the chest and neck C. Tachypnea, tachycardia, shortness of breath, petechial rash on the chest and neck D. Bradypnea, bradycardia, shortness of breath, petechial rash on the chest and neck

ANS- C. Tachypnea, tachycardia, shortness of breath, petechial rash on the chest and neck Rationale: 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.

Which condition can be prevented with anticoagulant drugs in a patient who underwent orthopedic surgery? A. Fat embolism B. Bone infection C. Thromboembolism D. Compartment syndrome

ANS- C. Thromboembolism Rationale: 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.

Upon a patient's return from vertebral disc surgery, which of the following would the nurse report to the health care provider immediately? A. Constipation B. Paresthesias C. Severe headache D. Abdominal distention

ANS- C. severe headache Rationale: The spinal cord may be entered during surgery, so a severe headache could potentially represent a cerebrospinal fluid leakage. Paresthesias, or numbness and tingling, may not be relieved immediately after surgery. It is normal for interference with bowel function to occur for several days following the surgery.

Which postoperative care, given by the nurse to the patient after a total hip replacement surgery, indicates an effective intervention? A. Allowing the patient to sit on chairs without arms. B. Allowing the patient to cross legs at the knees or ankles C. Allowing the patient to perform daily activities such as putting on shoes and socks D. Allowing the patient to use a pillow between the legs for the first six weeks after surgery

ANS- D. Allowing the patient to use a pillow between the legs for the first six weeks after surgery Rationale: 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.

When treating a patient with compartment syndrome, what measures should the nurse consider to be contraindicated? Select all that apply. A. Bandage removal. B. Bivalving of the bandage. C. Reduction in traction weight. D. Application of cold compresses. E. Elevation of the limb above heart level.

ANS- D. Application of cold compresses. E. Elevation of the limb above heart level. Rationale: 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.

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? A. Assess for temperature elevation and other signs of infection. B. Assess for excessive pain with passive stretch of the extremities. C. Assess vital signs and compare the quality of the pulses bilaterally. D. Assess the abdomen for decreased bowel sounds through a window in the brace.

ANS- D. Assess the abdomen for decreased bowel sounds through a window in the brace. Rationale: 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.

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? A. Paresthesia B. Pitting edema C. Poor venous return D. Compartment syndrome

ANS- D. Compartment syndrome Rationale: 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.

The nurse is assessing a patient who has a traumatic leg injury. What intervention is the most important in the initial assessment? A. Assess the patient's pain level B. Realign the extremity in the appropriate position C. Check for full or partial loss of feeling and sensation D. Determine the extremity's color and temperature in the area of the injury

ANS- D. Determine the extremity's color and temperature in the area of the injury Rationale: 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.

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? A. promote vitamin C and calcium intake in the diet B. provide passive range of motion to all of the joints q4hr. C. Keep the left leg in extension and abduction to prevent contractures. D. Encourage isometric quadriceps-setting exercises at least four times daily.

ANS- D. Encourage isometric quadriceps-setting exercises at least four times daily. Rationale: 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.

A patient with hypertension is admitted to the nursing unit with osteomyelitis. Which symptom will the nurse most likely find on physical examination? A. Hypotension B. Abdominal pain C. Nausea and vomiting D. Limited range of motion of the extremity

ANS- D. Limited range of motion of the extremity Rationale: Osteomyelitis is an infection of bone and bone marrow that can occur with trauma, surgery, or extension of nearby infection. Because it is an infection, the patient will exhibit typical signs of inflammation and infection, including localized pain and redness and limited movement of the affected extremity. Nausea, vomiting, and abdominal pain are not associated with osteomyelitis. If the infection leads to bacteremia, the patient may become hypotensive, indicating septic shock.

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? A. Avoid crossing his legs B. use a toilet elevator on toilet seat C. Notify future caregivers about the prosthesis D. Maintain hip in adduction and internal rotation

ANS- D. Maintain hip in adduction and internal rotation Rationale: 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.

The nurse is caring for a patient who underwent spinal surgery a day ago. A change in which clinical factor needs to be immediately reported to the primary health care provider? A. Pain intensity B. Urinary voiding C. Bowel movements D. Movement of the leg

ANS- D. Movement of the leg Rationale: Following a spinal surgery, the movement of the leg should be assessed. Ideally, it should be unchanged; any change in the leg movement indicates a complication and should be reported immediately. The pain intensity may increase due to surgery and muscle spasms. Urinary voiding and bowel movements may be changed, due to paralytic ileus and immobility.

What is the best intervention for a patient with an anterior cruciate ligament (ACL) injury who evidences tight and painful effusion? A. Applying ice B. Elevating the knee C. Administering aspirin D. Preparing for aspiration

ANS- D. Preparing for aspiration Rationale: 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.

Which type of surgical repair is performed during hemiarthroplasty? A. reshaping of the femoral head B. Repair with internal fixation devices C. replacement of both femur and acetabulum D. Replacement of part of the femur with prosthesis

ANS- D. Replacement of part of the femur with prosthesis Rationale: 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.

The nurse is providing discharge education to a patient with a fiberglass cast. What should the nurse be sure to include with the education? A. It must not get wet. B. The fiberglass is heavier than a plaster cast. C. It has to be replaced every one to two weeks. D. Skin irritation is more common than with a plaster cast.

ANS- D. Skin irritation is more common than with a plaster cast. Rationale: 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.

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? A. To assist with leg exercises B. To enhance breathing and lung expansion C. To promote circulation throughout the body D. To facilitate independent movement while the patient is in bed

ANS- D. To facilitate independent movement while the patient is in bed Rationale: 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.

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? Select all that apply. A. Abdominal pain B. Burning sensation C. Guarding and rigidity D. Nausea and vomiting E. Increased abdominal pressure

ANS- A. Abdominal pain D. Nausea and vomiting E. Increased abdominal pressure Rationale: 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.

Which postoperative drug class is used in the pain management of joint surgical procedures? A. Antibiotics B. Oral opioids C. Anticoagulants D. Corticosteroids

ANS- B. oral opioids Rationale: Oral opioids are part of the pharmacologic therapy to manage pain after joint surgical procedures. Antibiotics treat infection after surgery. Anticoagulants treat thromboembolism. Corticosteroids treat fat embolism.

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? A. Administer a dose of prescribed analgesic before completing the prescription. B. Ask the physical therapist for a walker to limit weight bearing while getting out of bed. C. Keep the continuous passive motion machine (CPM) in place while lifting the patient from bed to chair. D. Put on a knee immobilizer before moving the patient in and out of bed and keep the surgical leg elevated while sitting.

ANS- D. Put on a knee immobilizer before moving the patient in and out of bed and keep the surgical leg elevated while sitting. Rationale- 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.

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? A. Numbness, coolness, and loss of pulse B. Loss of sensation, redness, and warmth C. Coolness, redness, and inability to bear weight D. Redness, warmth, and inability to use the affected part

ANS- D. Redness, warmth, and inability to use the affected part Rationale: 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.