SKILLS- Prep u chapter 25

A nurse is fitting prophylactic braces to a client. What is the major function of prophylactic braces?

to prevent or reduce the severity of a joint injury

A client is wearing a cervical collar. Which statement by the client would indicate to the nurse that more teaching about use of the collar is necessary?

"I will be happy to take this collar off while I am sleeping."

The nurse is providing discharge education to client who has a cast applied for a distal radius fracture. The nurse recognizes the client has a knowledge deficit about caring for the cast when the client makes which statement?

"I will keep the cast covered with plastic at all times to protect it."

The nurse tells a newly casted client that "petals" will be applied. What is the appropriate nursing response when the client asks, "What are petals?"

"Pieces of moleskin that cover rough edges of the cast."

The nurse is preparing a client with a radial-ulnar fracture, and a history of multiple environme and chemical allergies, to be casted. When the client says, "I do not want one of those plaster casts," what is the appropriate priority nursing response?

"Plaster casts have a lower incidence of allergic reaction."

The nurse is preparing a 5-year-old child for application of a cast on the fractured right arm. The child is very upset and does not want a cast. Which is the best response from the nurse?

"The cast will hold your bones in place so they can heal."

After having a cast removed, a client anxiously says, "What happened to my arm? It is so much smaller now!" What is the appropriate nursing response?

"The unexercised muscle normally looks this way after cast removal."

client has suffered musculoskeletal trauma and requires mechanical immobilization. The client asks, "Why is this part of my treatment and is it necessary?" Which response from the nurse would be most appropriate?

"These types of injuries require a period of inactivity to allow new cells to restore integrity to damaged structures."

The nurse is caring for a client with a fractured femur who is being treated with skeletal traction. Which action(s) will the nurse implement when caring for this client? Select all that apply.

-Assess capillary refill. -Check for pedal pulses. -Alternate amount of weight applied.

The nurse is teaching the parent of a child who has been casted after a foot fracture how to assess circulation in the affected limb at home. Which teaching will the nurse provide? Select all that apply.

-Compare skin color between affected and non-affected limb. -Compress the toenail beds and look for color to return. -Touch both feet and assess for temperature differences. -Have child close eyes while parent touches foot to see if child notices.

The nurse working at an orthopedic center is assisting with cast application, including making and applying petals. Place the steps in the correct sequence. Use all options.

-Cut multiple strips of adhesive tape approximately 2 in (5 cm) wide by 2 to 3 in (5 to 7.5 cm) in length or use precut ovals from moleskin. -Round the end of each adhesive strip like a flower petal or trim to create chevrons that resemble arrows. -Tuck one end of the tape or moleskin inside the cast edge, taking care to avoid wrinkles. -Overlap the strips of tape or moleskin around the rough cast edge. -Continue to monitor the skin for signs of impairment.

The client fractured the left arm, and a plaster of Paris cast was applied. The client is now being discharged from the outpatient emergency clinic. The nurse is providing instructions to the client regarding care of the cast and arm. What instruction(s) will the nurse include? Select all that apply.

-Elevate the arm on a pillow covered with plastic. -Apply an ice pack to the fractured area of the casted arm. -Minimize movement of the fingers of the casted left arm.

A nurse is applying a cervical collar to a client with severe neck strain. Which actions should the nurse perform when applying a cervical collar? Select all that apply.

-Place the client's head in a neutral position. -Ensure that the collar openings are centered at the back of the neck. -Position the collar beneath the chin and then slide upward.

The nurse is caring for a client with a whiplash injury. When applying a cervical collar, which action(s) will the nurse take to ensure this intervention is completed safely and effectively? Select all that apply.

-Start with a collar placed well beneath the chin. -Ensure the opening of the collar is to the back. -Assess the client's work of breathing after the collar is applied.

A nurse is applying an ankle-foot orthosis to a client. What are the functions of this orthopedic device? Select all that apply.

-Support body part. -Align body part. -Correct deformities.

The nurse is caring for a client who had a cast applied to the left leg 2 days ago. Upon assessment, which finding(s) will lead the nurse to assess further for compartment syndrome? Select all that apply.

-The toes of the left leg are pink and warm. -Fluid is observed draining from under the cast. -The client has not ambulated since before the injury.

The nurse has gathered all supplies to perform pin care for a client with an external device. Place the steps of the skill in the correct sequence from first to last. Use all options.

-Wash hands or perform an alcohol-based hand rub. -Don gloves. -Open the package containing cotton-tipped applicators without touching the applicator tips. -Pour enough cleansing agent to saturate the dry applicators while holding them over a basin or wastebasket. -Cleanse the skin at the pin site moving outward in a circular manner. -Discard soiled supplies in an enclosed, lined container.

A client is having a fiberglass cast applied. The client says to the nurse, "Years ago, I had a plaster cast and it was not like this one. Is this better?" What advantage(s) of the fiberglass cast would the nurse cite? Select all that apply.

-light weight -porous -unaffected by water

The nurse is preparing to apply a cervical collar to a client. Which step(s) should the nurse perform in this process? Select all that apply.

-measure from the chin to shoulder -measure neck circumference -place opening of collar at back of neck

The health care provider has just applied a fiberglass cast to a client with a forearm fracture. How long will the nurse assure that the client holds the extremity in place while the cast dries?

15 minutes

The nurse is preparing a client with a displaced wrist fracture, and who reports pain of an "8" on a 1-10 scale, to undergo reduction and casting. When will the nurse plan to administer an opioid analgesic that has been prescribed?

15 minutes prior to procedure

The nurse is caring for a client with an elbow injury by placing an arm sling. Which degree of flexion will the nurse use as the maximum?

90

A client who has a cast on the arm is experiencing pain and tightness in the arm along with sluggish capillary refill. The nurse suspects compartment syndrome. What would be the appropriate intervention for this client?

Adjust the arm so that it is no higher than the heart level and call the health care provider.

The nurse is caring for a client who reports itching underneath an arm cast. Which nursing intervention is appropriate?

Administer an antihistamine and counsel the client that sleepiness is a side effect.

The nurse is caring for a client who is in skeletal traction. To prevent the complication of skin breakdown in this client, what measure will the nurse implement?

Assess the pin insertion site every 8 hours.

The nurse is caring for a client who is in traction and requires care of pin sites around the knee joint. The nurse notes thick yellowish white drainage from the pins. Which action will the nurse take first in response to this finding?

Consult infection control regarding swabbing the pin site.

The nurse is caring for a client who sustained an ankle fracture in a skiing accident this morning. After surgery, the leg and ankle were casted. At 1500, the client reports pain of "5" on a 1-10 scale. At 1700, pain has increased to a "7" despite pain control interventions. At 1900, the client reports pain of a "9" even following opioid medication administration. Which nursing intervention iS appropriate?

Contact the health care provider

The client twisted the wrist when playing baseball. Prior to discharge from the emergency clinic, the nurse will apply the prescribed sling. What action will the nurse perform to properly apply the arm sling?

Elevate the wrist slightly higher than the client's elbow.

A client is recovering from severe neck pain. What direction will the nurse give to assess the client's neuromuscular status?

Flex and extend the elbows and wrists.

The nurse is teaching a client on the proper use of the knee immobilizer. Which statement by the client will indicate to the nurse the teaching has been effective?

I can take the immobilizer off to shower and dress each morning.

A client with a recent fracture is suspected of having compartment syndrome. Data findings may include which symptoms?

Inability to perform passive movement, pain with active movement

The nurse is caring for a client who has been placed in traction for a fractured femur following a motor vehicle collision. Pins have been surgically placed at the site of the fracture. Which action will the nurse take to increase the client's level of comfort?

Insert padding within the pulley sling around the leg.

The nurse is caring for a client who sustained a mild neck sprain in a motor vehicle accident. What teaching regarding the use of a cervical collar will the nurse include?

Limit neck and head movements.

The nurse is caring for a client who sustained a mild neck sprain while playing football. What teaching regarding the use of a cervical collar will the nurse include?

Limit neck and head movements.

The nurse plans care for a client that will require skeletal traction for 2 weeks. Which intervention will the nurse include?

Limit the client's positions to those prescribed.

A client has undergone an external fixation for a fractured femur incurred after a fall down the stairs. Which action would be the priority for this client?

Maintain pin site care.

An adolescent boy has suffered an arm fracture during a football game and been brought to the emergency department by his coach. The boy is adamant in his preference for a splint rather than a cast. Why do skeletal injuries require mechanical immobilization?

Musculoskeletal injuries heal much more slowly than soft tissue injuries.

The nurse is assisting with the application of a plaster cast on an adolescent client with a femoral shaft fracture. The client's parent asks how long it will take for the cast to dry. What response from the nurse is correct?

Nearly 72 hours

The nurse is caring for a 16-year-old client who is in skeletal traction following a motor vehicle accident. The client's temperature is 101.5°F (38.6°C) and the client's blood pressure and pulse are elevated. Which action will the nurse take next?

Obtain a urine sample for analysis.

The nurse is providing emergency care to a client who sustained and ankle injury while playng basketball. When assisting with applying an emergency splint, which action will the nurse take?

Pad bony prominences of the ankle with soft material.

The nurse is caring for an older adult client who has pain and loss of function associated with arthritis. Which nursing teaching is appropriate?

Physical and occupational therapy may be initially helpful.

The nurse is caring for a client who is hospitalized after a motor vehicle accident. The client has a plaster cast on the right arm. The client reports pruritis to the skin beneath the cast. What nonpharmacologic intervention is best for the nurse to implement?

Position a blow dryer on cool air setting into a small opening in the cast.

The client fell at home and fractured the right hip. The client was placed in Buck traction and is awaiting surgery that is scheduled 4 hours from now. The client is supine. The right leg is turned outward. The client reports pain as 2 on a scale of 0 to 10. What action will the nurse take first?

Position the client's right leg in proper alignment.

The nurse is caring for a client who requires a canvas sling to immobilize the injured arm. Which action by the nurse is appropriate when applying the sling?

Position the forearm across the client's chest with the thumb pointing upward.

The nurse is assisting with the application of a plaster of Paris cast for a client with a fractured radius. Which nursing action is appropriate to reduce the client's anxiety about the procedure?

Provide a step-wise explanation of the procedure prior to beginning.

A nurse is caring for a client with a cervical halter applied. Which intervention should the nurse perform when caring for this client?

Provide a trapeze or an overbed frame to the client.

The nurse is caring for a client with a hip spica cast. Which nursing intervention is appropriate to assist the client with elimination?

Provide fracture pan as needed.

The nurse is caring for a client in skeletal traction. What action will the nurse take to prevent the client's bony fragments from moving against one another?

Remind the client not to turn side to side.

The nurse is providing care to a client who is in traction for a fractured femur. Which intervention will the nurse include in this client's care plan?

Remove and apply bottom bed linen starting from the foot of the bed.

When planning care for a client with an external fixator on the right lower leg, ankle, and foot, which nursing diagnosis will the nurse assign to address the assessment findings of reddened skin and tenderness at the pin sites, temperature of 100°F (37.77°C), and foot warm to the touch?

Risk for infection

The nurse is caring for a client who has been placed into Buck's traction. Which type of traction intervention does the nurse document that this is?

Skin

The nurse is preparing a client for cast removal. Which teaching will the nurse provide to the client?

The cast will be removed with an electric cast cutter.

A nurse has assisted with the application of a cervical collar. What would indicate that the collar was applied correctly?

The client is breathing and swallowing without effort.

The client had a surgical procedure performed on the left arm. The arm has an external fixator applied and is elevated on a pillow. The nurse performs assessments every hour postoperatively. What finding will the nurse assess as normal?

The left radial pulse is regular, 2+, and equal to the right radial pulse.

A nurse is assisting with the application of a traction splint. What is an example of a traction splint?

Thomas splint

The urgent care nurse is assessing a client who had a plaster cast applied to the left ankle 4 hours ago. The client has come back to the urgent care with concerns. Which finding requires immediate nursing intervention?

Toes are dry and cool to touch.

The telehealth nurse is speaking with a parent whose child jumped off a couch and now is crying and holding the forearm. Which teaching will the nurse provide regarding emergency splinting?

Use a rigid splinting material.

The client incurred a severe fracture of the tibia. An external fixator was applied. Daily pin site care is prescribed. What action will the nurse perform while providing pin site care?

Use a separate swab for each pin site.

The nurse is inspecting the skin of a client who has just had a cast removed from the right arm. The nurse notes flaps of scaly dead skin on the arm. Which action will the nurse take in response to this finding?

Wash the skin with warm water and soap

The nurse is inspecting the skin of a client who has just had a cast removed from the right arm. The nurse notes flaps of scaly dead skin on the arm. Which action will the nurse take in response to this finding?

Wash the skin with warm water and soap.

A nurse is caring for a client with a cervical collar. What should the nurse include in the client teaching regarding the use of the cervical collar?

Wear the collar even when sleeping.

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene?

Weights hanging and touching the floor

A client was fitted with a cast this morning after fracturing the left ulna and radius in a workplace accident. Which actions should the nurse prioritize in the care of this client?

assessing the neurovascular status of the client's hand

A nurse is helping to position a triangular sling. Why does the nurse position the sling to the side of the neck?

avoids pressure on the vertebrae

The nurse is caring for a client who had a cast applied yesterday for a tibia fracture. When the client returns today with swelling in that extremity, for which procedure does the nurse prepare?

bivalving of the cast

The nurse is assisting with the application of a cast. What would the nurse expect to be done first?

cleaning the skin surface

The nurse is assessing a client who has been diagnosed with an ankle sprain. The nurse will prepare to provide instructions to the client on how to care for which type of immobilization device?

commercial splint

The nurse is caring for a client with a casted left leg. The nurses notes indicate an analgesic was administered 45 minutes prior and the leg has been elevated. The client continues to report having pain and rates it 9 out of 10. The nurse assess the client's capillary refill at greater than 3 seconds. The nurse suspects the client may be developing which complication?

compartment syndrome

An unlicensed assistive personnel (UAP) has alerted the nurse that a client who is 36 hrs postoperative for a fracture of the tibia/fibula is having difficulties. Which action should the nurse prioritize after reviewing the UP's report?

contact health care provider immediately

While preparing a client with a forearm fracture for casting, the nurse washes and dries the skin. Which nursing action is next?

covering arm with stockinette

A client with severe arthritis needs temporary immobilization of the wrist and hand. Which type of cast does the nurse anticipate will be ordered?

cylinder bivalve

76-year-old client experienced trauma and requires mechanical immobilization. While developing a care plan, the nurse identifies which factor as a potential concern related to impaired skin integrity?

diminished tactile sensation

A client has arrived to the unit after transfer from the postanesthesia care unit (PACU). The client had a pin placed in the left mid femur to repair a fracture. As the nurse reviews the health care provider's orders to care for the client, which task should the nurse prioritize?

ensure bed is at correct height

The nurse in a long-term care facility is checking on a client who had a cast applied 48 hours ago to the right ankle for a fracture. Which action should the nurse take?

ensure client changes position every 2 hours

A client with an arm cast and sling is having a routine follow-up appointment to check on the progress of the healing fracture. Which assessment finding requires nursing intervention?

fingers of casted arm are cool to touch

A client with an unstable patella has seen the health care provider to discuss options to provide stability to this joint. Which type of immobilizer does the nurse anticipate applying?

functional brace

The nurse is caring for a 21-year-old professional ballerina who sustained a knee sprain while dancing. Which splint will the nurse prepare to apply?

immobilizer

The nurse is caring for a client who has a dislocated shoulder. Which type of traction intervention does the nurse anticipate will be used to address this concern?

manual

The nurse is caring for a client with carpal tunnel syndrome. Which type of splint does the nurse anticipate will be ordered?

molded

A client has carpal tunnel syndrome. Part of the management plan is the use of a device to limit movement. Which device would the nurse expect this client to use?

molded splint

A client who has had repetitive knee injuries sustained while playing sports asks about reducing the severity of the most current knee sprain. Which type of immobilizer will the nurse anticipate applying?

prophylactic brace

The nurse is performing a health history for a client who had a previous medial collateral ligament (MCL) injury of the knee while playing football. The client intends to continue to play this sport but worries about re-injuring the knee. The nurse anticipates the need to provide instructions for the application of which type of immobilizing device?

prophylactic brace

The nurse is caring for a client who recently had a cast removed after surgery to correct a fractured ankle. Which type of immobilizer will the nurse anticipate applying?

rehabilitative brace

A nurse is caring for an athlete who has been provided with a cervical collar to immobilize the neck following a neck injury. What is the most important advantage of mechanical immobilization of a body part?

relieves pain and muscle spasm

The nurse is providing care to a client who has sustained an injury to the left arm in a motor vehicle accident. When discharging the client, which teaching instructions will the nurse provide?

"Call your health care provider immediately if your pain is unmanageable."

The nurse is preparing a client with an arm fracture for plaster casting. The client reports, "I forgot to tell the provider that I have chemical and environmental allergies." What is the appropriate initial nursing response?

"Help me understand more about your allergies."

School-age children are attending a summer camp. On a hike, one of the campers fell and sustained an open fracture of the leg. The nurse is at the site, awaiting arrival of emergency personnel. What is the most important action of the nurse?

Cover the open wound with clean gauze.

A client has sustained a long bone fracture. The nurse is preparing a care plan for this client. Which intervention should the nurse include to enhance fracture healing?

Monitor color, temperature, and pulses of the affected extremity.

Upon cast assessment of a client with an open tibia fracture, the nurse notices yellowish drainage coming from within the cast. Which nursing intervention is appropriate?

Monitor white blood cell count.

The nurse is caring for a client who required hip pinning during surgery to repair a hip fracture. When the nurse is performing pin site care for this client, the nurse will follow which guideline?

Use each sterile applicator once and discard.

A nurse is caring for a male client who has recently been fitted with a cast following a tibial fracture. Which assessment findings would be suggestive of neurovascular dysfunction?

The client is unable to wiggle his toes on demand.

The nurse is caring for a client who has had a shoulder spica made of plaster of paris applied. Which teaching will the nurse provide to the client?

The client should expect to feel that the cast is hot and heavy.

The nurse is caring for a client who has had a shoulder spica made of plaster of paris applied. which teaching will the nurse provide to the client?

The client should expect to feel that the cast is hot and heavy.

The nurse is assessing a client diagnosed with rheumatoid arthritis. The client reports a recent onset of numbness, tingling and weakness of the right wrist and hand since an increasing amount of computer work has been added to the work day. Which immobilization device does the nurse anticipate the client will need?

molded splint

The nurse is showing a client "petals" that will be applied to a forearm cast. When the client asks, "What are those for?" what teaching will the nurse provide?

moleskin pieces that cover the cast's rough edges

The nurse is caring for a client who had a leg cast applied 24 hours earlier, and has returned to the emergency department (ED) reporting pain of "9" on a 1-10 scale. Which additional assessment finding does the nurse anticipate?

swelling within fascia that does not expand

A nurse at an outpatient clinic is conducting an assessment of a female client who has been wearing a foam cervical collar since being involved in a motor vehicle accident the week prior. What is the primary purpose of this mechanical immobilization device?

to remind the client to limit range of motion of her neck