Prep U questions chapter 37

A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? Select all that apply.

- "I cannot seem to catch my breath." - "I have a pins-and-needles sensation in my toes." - Dorsoplantar weak and unequal bilaterally - T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90%

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

Pelvic fractures

Which is not a guideline for avoiding hip dislocation after replacement surgery.

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes

A client comes to the emergency department and reports localized pain and swelling in the lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. What will the nurse most likely suspect?

Contusion

A client reports pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The client was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury?

Sprain

The nurse is caring for a patient with a total hip replacement. How should the nurse allow the patient to turn?

45 degrees onto the unoperated side if the affected hip is kept abducted

Which type of fracture is one in which the skin or mucous membrane wound extends to the fractured bone?

Compound

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

Hypovolemic shock

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

Impacted

A client who has undergone a lower limb amputation is preparing to be discharged home. What outcome is necessary prior to discharge?

Client can demonstrate safe use of assistive devices

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse?

"Describe the pain and rate it on the pain scale."

A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse?

"Elevating the leg might lead to a flexion contracture."

The nurse is admitting a client who is to undergo an open reduction with internal fixation for a fractured femur. About which comment by the client should the nurse be most concerned?

"I was worried I would have an incision and scar."

A client is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The client is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement?

"The physical therapist will likely help you get up using a walker the day after your surgery."

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker?

24 hours

A patient sustains an open fracture with extensive soft tissue damage. The nurse determines that this fracture would be classified as what grade?

3

A client is about to have a cast applied to the left arm. The nurse will tell the client to expect which of the following?

A sensation of warmth or heat with application

A client presents at an ambulatory clinic and reports pain and aching in the lower left leg. After examining the client, a health care provider determines the client has experienced a strain related to the client's exercise regimen. The treatment plan includes analgesics, rest, and cold and heat therapies. Which guideline should be included in the care plan?

Aftere 24 hours, apply heat for peroids of 15 to 30 minutes

A client with a fractured femur is placed in skeletal traction. Which intervention will increase client independence when moving in bed?

Apply a trapeze to the bed frame

A group of students are reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?

Better molding to the client

The nurse teaching the client with a cast about home care includes which instruction?

Dry a wet fiberglass cast thoroughly to avoid skin problem

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate?

Explain that the sensation being felt is normal and will not burn the client

A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture?

Incomplete

A client experienced an open fracture to the left femur during a horse-riding accident. For which complication is this client at highest risk?

Infection

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

Infection related to effects of trauma

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention?

Keep the cast clean and dry

A client who was in a motor vehicle crash is diagnosed with a stable T7 spinal fracture with no neurologic deficits. Which nursing intervention should the nurse implement?

Maintain bed rest with the head of the bed at 20 degrees

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period?

Osteomyelitis

Which nursing diagnosis is a priority for a client with a traumatically amputated lower extremity?

Risk for injury related to amputation

A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied?

Short leg cast

Which principle applies to the client in traction?

Skeletal traction is never interrupted

Six weeks after an above-the-knee amputation (AKA), a client returns to the outpatient office for a routine postoperative checkup. During the nurse's assessment, the client reports symptoms of phantom pain. What should the nurse tell the client to do to reduce the discomfort of the phantom pain?

Take opioid analgesics as prescribed

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan?

Teach the client how to prevent problems caused by immobility

An elite high school football player has been diagnosed with a shoulder dislocation. The client has been treated and is eager to resume his role on his team, stating that he is not experiencing pain. What should the nurse emphasize during health education?

The importance of adhering to the prescribed treatment and rehabilitation regimen

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for?

Total arthroplasty

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication?

Dislocation of the hip

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

Hemorrhage and shock

A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client?

Cutting a cast window

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation?

Abduction

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.)

- Decreased sensory function - Excruciating pain - Loss of motion

Which of the following type of fracture is associated with osteoporosis?

Compression

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority?

Maintaining traction continuously to ensure its effectiveness

A client with a right leg fracture is returning to the orthopedist to have the cast removed. During cast removal, it is important for the nurse to assure:

The client that he or she won't be cut

The nurse is assigned to care for a client who has had an open reduction and internal fixation of a fractured right femur 2 days ago. The nurse is listening to the client's lungs and, when moving the gown, observes petechial hemorrhages on the skin of the chest. What is the first action by the nurse?

Call the physician to inform them of the findings

In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor in the client?

Compartment syndrome

A client who has fallen and injured a hip cannot place weight on the leg and is in significant pain. After radiographs indicate intact but malpositioned bones, what would the physician diagnose?

Dislocation

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

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

A client has returned to the postsurgical unit from the PACU after an above-the-knee amputation of the right leg. Results of the nurse's initial postsurgical assessment were unremarkable but the client has called out. The nurse enters the room and observes copious quantities of blood at the surgical site. What should be the nurse's initial action?

Apply a tourniquet

A client has been diagnosed with a muscle strain. What does the physician mean by the term "strain"?

Stretched or pulled beyond its capacity

The nurse is helping to set up Buck's traction on an orthopedic client. How often should the nurse assess circulation to the affected leg?

Within 30 minutes, then every 1 to 2 hours

Which would be contraindicated as a component of self-care activities for the client with a cast?

Cover the cast with plastic to insulate it

Which factor may contribute to compartment syndrome?

Hemorrhage

The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury?

Hypovolemic

Which intervention should the nurse implement with the client who has undergone a hip replacement?

Instruct the client to avoid internal rotation of the leg

A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for?

Left hip arthroplasty

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

Provide feedback on the client's strengths and available resources

Which statement describes external fixation?

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins

A client is experiencing pain, joint instability, and difficulty walking due to an injury to the knee ligaments. The injury was judged not to require surgery. Which intervention would not be included in this client's care?

Traction

A patient sustains an open fracture of the left arm after an accident at the roller skating rink. What does emergency management of this fracture involve? (Select all that apply.)

- Covering the area with a clean dressing if the fracture is open - Immobilizing the affected site - Splinting the injured limb

An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement?

Avascular necrosis may develop at the site if it is not promptly resolved

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?

Between 24 and 48 hours

A fracture is considered pathologic when it

Occurs through an area of diseased bone

An older adult client experienced a fall and required treatment for a fractured hip on the orthopedic unit. Which of the following are contributory factors to the incidence of falls and fractured hips among the older adult population? Select all that apply.

-Loss of visual acuity - Adverse medication effects - Slowed reflexes - Muscle weakness

Which client(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply.

-The client with elevated pressure within the muscles - The client with hemorrhage in the site of injury - The client with a plaster cast applied immediately after injury

A client had an above-the-knee amputation of the left leg related to complications from peripheral vascular disease. The nurse enters the client's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse?

Apply a tourniquet

A client with a fractured femur is in balanced suspension traction. The client needs to be repositioned toward the head of the bed. During repositioning, what should the nurse do?

Maintain consistent traction tension while repositioning

Which is a hallmark sign of compartment syndrome?

Pain

A client is diagnosed with a first-degree strain of the left ankle related to running 5 miles daily. How would the nurse differentiate the first-degree strain from other strains and sprains?

The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices

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

With the leg on the affected side abducted

Which factor inhibits fracture healing?

Local malignancy

A nurse is caring for a client who has sustained ligament and a meniscal injury to the knee. Which action would be most appropriate to allow the client to progress without causing further injury?

Assist with a gradual introduction of activity

A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose?

Contusion

The nurse is caring for a client who had a total knee replacement 3 days ago. Which nursing assessment finding requires immediate attention by the nurse?

Drainage from wound suction device = 100 ml

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign?

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg

Which action would be most important postoperatively for a client who has had a knee or hip replacement?

Assisting in early ambulation

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect?

Avascular necrosis

A nurse is performing a shift assessment on an elderly client who is recovering after surgery for a hip fracture. The client reports chest pain, has an increased heart rate, and increased respiratory rate. The nurse further notes that the client is febrile and hypoxic, coughing, and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this client is likely demonstrating symptoms of what complication?

Fat embolism syndrome

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

Compound

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture?

Encourage participation in ADLs

A client has sustained a long bone fracture and the nurse is preparing the client's care plan. Which of the following should the nurse include in the care plan?

Monitor temperature and pulses of the affected extremity

The nurse is caring for a client who has had a fracture reduction using a cast. What is most important for the nurse to assess?

Neurovascular status

Which term refers to the failure of fragments of a fractured bone to heal together?

Nonunion

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

Prevent internal rotation of the affected leg

A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse?

"A splint is applied when more swelling is expected at the site of injury."

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply.

- Muscle spasms will be relieved - The bones of the left leg will be aligned - Immobilization of the left leg will be maintained

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply.

- Skin breakdown - Wound infection - Pneumonia

The nurse advises a 36-year-old patient who suffered a severe wrist sprain subsequent to a fall that she can begin progressive passive and active exercises in:

1 to 3 weeks - Depending on the severity of the injury, exercises can begin from 2 to 5 days (mild) or 1 to 3 weeks (severe).

The orthopedic surgeon has prescribed balanced skeletal traction for a client. What advantage is conferred by balanced traction?

Balanced traction allows for greater client movement and independence than other forms of traction