Musculoskeletal Trauma and Orthopedic Surgery (Ch. 62)

A patient with a right lower leg fracture will be discharged home with an external fixation device in place. Which statement should the nurse including in discharge teaching? A. "Check and clean the pin insertion sites daily." B. "Remove the external fixator for your shower." C. "Remain on bed rest until bone healing is complete." D. "Take prophylactic antibiotics until the fixator is removed."

A. "Check and clean the pin insertion sites daily."

Which action should the nurse take to evaluate the effectiveness of Buck's traction for a patient who has an intracapsular fracture of the right femur? A. Assess for hip pain. B. Check for contractures. C. Palpate peripheral pulses. D. Monitor for hip dislocation.

A. Assess for hip pain.

A patient undergoes left above-the-knee amputation with an immediate prosthetic fitting. What should the nurse do when the patient arrives on the orthopedic unit after surgery? A. Assess the surgical site for hemorrhage. B. Remove the prosthesis and wrap the site. C. Place the patient in a side-lying position. D. Keep the residual limb elevated on a pillow.

A. Assess the surgical site for hemorrhage.

A patient who has had open reduction and internal fixation (ORIF) of a hip fracture tells the nurse he is ready to get out of bed for the first time. Which action should the nurse take? A. Check the patient's prescribed weight-bearing status. B. Use a mechanical lift to transfer the patient to the chair. C. Decrease the pain medication before getting the patient up. D. Have the unlicensed assistive personnel (UAP) transfer the patient.

A. Check the patient's prescribed weight-bearing status.

A patient who had open reduction and internal fixation (ORIF) of left lower leg fractures continues to report severe pain in the leg 15 minutes after receiving the prescribed IV morphine. The nurse determines pulses are faintly palpable and the foot is cool to the touch. Which action should the nurse take next? A. Notify the health care provider. B. Assess the incision for redness. C. Reposition the left leg on pillows. D. Check the patient's blood pressure.

A. Notify the health care provider.

What should the occupational health nurse advise a patient whose job involves many hours of typing? A. Obtain a keyboard pad to support the wrist. B. Do stretching exercises before starting work. C. Wrap the wrists with compression bandages every morning. D. Avoid using nonsteroidal antiinflammatory drugs (NSAIDS).

A. Obtain a keyboard pad to support the wrist.

For a patient who has had right hip arthroplasty, which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP)? A. Reposition the patient every 1 to 2 hours. B. Assess for skin irritation on the patient's back. C. Teach the patient quadriceps-setting exercises. D. Determine the patient's pain intensity and tolerance.

A. Reposition the patient every 1 to 2 hours.

Which statement by a patient who has had an above-the-knee amputation indicates the nurse's discharge teaching has been effective? A. "I should elevate my residual limb on a pillow 2 or 3 times a day." B. "I should lie flat on my abdomen for 30 minutes 3 or 4 times a day." C. "I should change the limb sock when it becomes soiled or each week." D. "I should use lotion on the stump to prevent skin drying and cracking."

B. "I should lie flat on my abdomen for 30 minutes 3 or 4 times a day."

A tennis player has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. Which information will the nurse include in postoperative teaching? A. "You will not be able to serve a tennis ball again." B. "You will begin work with a physical therapist tomorrow." C. "Keep the shoulder immobilizer on for the first 4 days to minimize pain." D. "The surgeon will use the drop arm test to determine the success of surgery."

B. "You will begin work with a physical therapist tomorrow."

After being hospitalized for 3 days with a right femur fracture, a patient suddenly develops shortness of breath and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first? A. Stay with the patient and offer reassurance. B. Administer prescribed PRN O2 at 4 L/min. C. Check the patient's legs for swelling or tenderness. D. Notify the health care provider about the symptoms.

B. Administer prescribed PRN O2 at 4 L/min.

The day after a having a right below-the-knee amputation, a patient reports pain in the missing right foot. Which action is most important for the nurse to take? A. Explain the reasons for the pain. B. Administer prescribed analgesics. C. Reposition the patient to assure good alignment. D. Tell the patient that the pain will diminish over time.

B. Administer prescribed analgesics.

Before assisting a patient with ambulation 2 days after total hip arthroplasty, which action is most important for the nurse to take? A. Observe output from the surgical drain. B. Administer prescribed pain medication. C. Instruct the patient about benefits of early ambulation. D. Change the dressing and document the wound appearance.

B. Administer prescribed pain medication.

Which action should the urgent care nurse take for a patient with a possible knee meniscus injury? A. Encourage bed rest for 24 to 48 hours. B. Apply an immobilizer to the affected leg. C. Avoid palpation or movement of the knee. D. Administer intravenous opioids for pain management.

B. Apply an immobilizer to the affected leg.

The nurse should instruct a patient with a nondisplaced fractured left radius that the cast will need to remain in place for what amount of time? A. Two weeks B. At least six weeks C. Until swelling of the wrist has resolved D. Until x-rays show complete bony union

B. At least six weeks

The nurse is caring for a patient who is using Buck's traction after a hip fracture. Which action can the nurse delegate to experienced unlicensed assistive personnel (UAP)? A. Remove and reapply traction periodically. B. Ensure the weight for the traction is hanging freely. C. Monitor the skin under the traction boot for redness. D. Check for intact sensation and movement in the affected leg.

B. Ensure the weight for the traction is hanging freely.

Which information should the nurse include in discharge teaching for a patient who has had a repair of a fractured mandible? A. Administration of nasogastric tube feedings B. How and when to cut the immobilizing wires C. The importance of high-fiber foods in the diet D. The use of sterile technique for dressing changes

B. How and when to cut the immobilizing wires

A patient who arrives at the emergency department with severe left knee pain is diagnosed with a patellar dislocation. What should be the nurse's initial focus for patient teaching? A. Use of a knee immobilizer B. Monitored anesthesia care C. Physical activity restrictions D. Performance of gentle knee flexion

B. Monitored anesthesia care

Which information about a patient with a lumbar vertebral compression fracture should the nurse immediately report to the health care provider? A. Patient declines to be turned due to back pain. B. Patient has been incontinent of urine and stool. C. Patient reports lumbar area tenderness to palpation. D. Patient frequently uses oral corticosteroids to treat asthma.

B. Patient has been incontinent of urine and stool.

After change-of-shift report, which patient should the nurse assess first? A. Patient with a repaired mandibular fracture who is reporting facial pain. B. Patient with repaired right femoral shaft fracture who reports tightness in the calf. C. Patient with an unrepaired Colles' fracture who has right wrist swelling and deformity. D. Patient with an unrepaired intracapsular left hip fracture whose leg is externally rotated.

B. Patient with repaired right femoral shaft fracture who reports tightness in the calf.

A 60-yr-old patient had open reduction and internal fixation (ORIF) for an open, displaced tibial fracture, What should the nurse identify as the priority patient problem? A. Acute pain B. Risk for infection C. Activity intolerance D. Risk for constipation

B. Risk for infection

A patient who is to have no weight bearing on the left leg is learning to use crutches. Which observation by the nurse indicates the patient can safely ambulate independently? A. The patient moves the right crutch with the right leg and then the left crutch with the left leg. B. The patient advances the left leg and both crutches together and then advances the right leg. C. The patient uses the bedside chair to assist in balance as needed when ambulating in the room. D. The patient keeps the padded area of the crutch firmly in the axillary area when ambulating.

B. The patient advances the left leg and both crutches together and then advances the right leg.

Which patient statement indicates understanding of the nurse's teaching about a new short-arm synthetic cast? A. "I can remove the cast in 4 weeks using industrial scissors." B. "I should avoid moving my fingers until the cast is removed." C. "I will apply an ice pack to the cast over the fracture site off and on for 24 hours." D. "I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast."

C. "I will apply an ice pack to the cast over the fracture site off and on for 24 hours."

A high school teacher with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for arthroplasty of several joints in the left hand. Which patient statement to the nurse indicates a realistic expectation for the surgery? A. "This procedure will correct the deformities in my fingers." B. "I will not have to do as many hand exercises after the surgery." C. "I will be able to use my fingers with more flexibility to grasp things." D. "My fingers will appear more normal in size and shape after this surgery."

C. "I will be able to use my fingers with more flexibility to grasp things."

After the health care provider recommends amputation for a patient who has nonhealing ischemic foot ulcers, the patient tells the nurse that he would rather die than have an amputation. Which response by the nurse is best? A. "You are upset, but you may lose the foot anyway." B. "Many people are able to function with a foot prosthesis." C. "Tell me what you know about your options for treatment." D. "If you do not want an amputation, you do not have to have it."

C. "Tell me what you know about your options for treatment."

A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which assessment finding should indicate to the nurse a potential complication of the fracture? A. The patient states the pelvis feels unstable. B. The patient reports pelvic pain with palpation. C. Abdomen is distended, and bowel sounds are absent. D. Ecchymoses are visible across the abdomen and hips.

C. Abdomen is distended, and bowel sounds are absent.

After a motorcycle accident, a patient arrives in the emergency department with severe swelling of the left lower leg. Which action should the nurse take first? A. Elevate the leg on 2 pillows. B. Apply a compression bandage. C. Assess leg pulses and sensation. D. Place ice packs on the lower leg.

C. Assess leg pulses and sensation.

The second day after admission with a fractured pelvis, a patient suddenly develops confusion. Which action should the nurse take first? A. Take the blood pressure. B. Check the O2 saturation. C. Assess patient orientation. D. Observe for facial asymmetry.

C. Assess patient orientation.

A patient who slipped and fell in the shower at home has a proximal left humerus fracture immobilized with a sling. Which intervention should the nurse include in the plan of care? A. Use surgical net dressing to hang the arm from an IV pole. B. Immobilize the fingers of the left hand with gauze dressings. C. Assess the left axilla and change absorbent dressings as needed. D. Assist the patient in passive range of motion (ROM) for the right arm.

C. Assess the left axilla and change absorbent dressings as needed.

A pedestrian who was hit by a car is admitted to the emergency department with possible right lower leg fractures. What initial action should the nurse take? A. Elevate the right leg. B. Splint the lower leg. C. Assess the pedal pulses. D. Verify tetanus immunization.

C. Assess the pedal pulses.

What should the nurse include when teaching older adults at a community recreation center about ways to prevent fractures? A. Tack down scatter rugs on the floor in the home. B. Expect most falls to happen outside the home in the yard. C. Buy shoes that provide good support and are comfortable to wear. D. Get instruction in range-of-motion exercises from a physical therapist.

C. Buy shoes that provide good support and are comfortable to wear.

Which information should the nurse include in discharge instructions for a patient with comminuted left forearm fractures and a long-arm cast? A. Keep the left shoulder elevated on a pillow or cushion. B. Avoid nonsteroidal antiinflammatory drugs (NSAIDs). C. Call the health care provider for numbness of the hand. D. Keep the hand immobile to prevent soft tissue swelling.

C. Call the health care provider for numbness of the hand.

Which finding in a patient with a Colles' fracture of the left wrist should the nurse identify as most important to communicate immediately to the health care provider? A. The patient reports severe pain. B. Swelling is noted around the wrist. C. Capillary refill to the fingers is slow. D. The wrist has a deformed appearance.

C. Capillary refill to the fingers is slow.

The nurse is caring for a patient who has a pelvic fracture and an external fixation device. How should the nurse perform assessment of pressure areas and provide skin care to the patient's back and sacrum? A. Ask the patient to turn to the side independently. B. Defer back assessment until the patient is ambulatory. C. Have the patient lift the back and buttocks using a trapeze. D. Roll the patient over to the side by pushing on the patient's hips.

C. Have the patient lift the back and buttocks using a trapeze.

A patient is being discharged 4 days after hip arthroplasty using the posterior approach. Which patient action requires intervention by the nurse? A. Using crutches with a swing-to gait B. Sitting upright on the edge of the bed C. Leaning over to pull on shoes and socks D. Bending over the sink while brushing teeth

C. Leaning over to pull on shoes and socks

A patient is admitted to the emergency department with a left femur fracture. Which assessment finding by the nurse is most important to report to the health care provider? A. Bruising of the left thigh B. Reports of severe thigh pain C. Slow capillary refill of the left foot D. Outward pointing toes on the left foot

C. Slow capillary refill of the left foot

A patient arrived at the emergency department after tripping over a rug and falling at home. Which finding should the nurse identify as most important to communicate to the health care provider? A. There is bruising at the shoulder area. B. The patient reports arm and shoulder pain. C. The right arm appears shorter than the left. D. There is decreased shoulder range of motion.

C. The right arm appears shorter than the left.

When a patient arrives in the emergency department with a facial fracture, which action should the nurse take first? A. Assess for nasal bleeding and pain. B. Apply ice to the face to reduce swelling. C. Use a cervical collar to stabilize the spine. D. Check the patient's alertness and orientation

C. Use a cervical collar to stabilize the spine.

Which discharge instruction should the emergency department nurse include for a patient with a sprained ankle? A. Keep the ankle loosely wrapped with gauze. B. Apply a heating pad to reduce muscle spasms. C. Use pillows to elevate the ankle above the heart. D. Gently move the ankle through the range of motion.

C. Use pillows to elevate the ankle above the heart.

A patient is to be discharged from the hospital 4 days after insertion of a femoral head prosthesis using a posterior approach. Which patient statement to the nurse indicates that additional teaching is needed? A. "I should not cross my legs while sitting." B. "I will use a toilet elevator on the toilet seat." C. "I will have someone else put on my shoes and socks." D. "I can sleep in any position that is comfortable for me."

D. "I can sleep in any position that is comfortable for me."

A factory line worker has repetitive strain syndrome in the left elbow. What topic should the nurse plan to include in patient teaching? A. Surgical options B. Elbow injections C. Wearing a left wrist splint D. Modifying arm movements

D. Modifying arm movements

Which action should the nurse include in the plan of care for a patient who had a cemented right total knee arthroplasty? A. Avoid extension of the right knee beyond 120 degrees. B. Use a compression bandage to keep the right knee flexed. C. Teach about the need to avoid weight bearing for 4 weeks. D. Start progressive knee exercises to obtain 90-degree flexion.

D. Start progressive knee exercises to obtain 90-degree flexion.

A patient has possible right carpal tunnel syndrome. What symptom should the nurse expect with a positive Tinel's sign? A. Weakness in the right little finger B. Burning in the right elbow and forearm C. Tremor when gripping with the right hand D. Tingling in the right thumb and index finger

D. Tingling in the right thumb and index finger

A young adult arrives in the ED with ankle swelling and severe pain after twisting an ankle playing basketball. Which prescribed action will the nurse implement first? A. Send the patient for ankle x-rays. B. Administer naproxen (Naprosyn). C. Give acetaminophen with codeine. D. Wrap the ankle and apply an ice pack.

D. Wrap the ankle and apply an ice pack.

In which order should the nurse complete actions when caring for a patient in the emergency department who has a right leg fracture? (Put a comma and a space between each answer choice [A, B, C, D, E, F].) a. Obtain x-rays. b. Check pedal pulses. c. Assess lung sounds. d. Take blood pressure. e. Apply splint to the leg f. Administer tetanus prophylaxis.

c. Assess lung sounds. d. Take blood pressure. b. Check pedal pulses. e. Apply splint to the leg a. Obtain x-rays. f. Administer tetanus prophylaxis.