CH 43

Which type of fracture involves a break through only part of the cross-section of the bone? a) Open b) Incomplete c) Oblique d) Comminuted

Incomplete Explanation: An incomplete fracture involves a break through only part of the cross-section of the bone. A comminuted fracture is one that produces several bone fragments. An open fracture is one in which the skin or mucous membrane wound extends to the fractured bone. An oblique fracture runs across the bone at a diagonal angle of 45 to 60 degrees.

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment? a) Malunion b) Subluxation c) Delayed union d) Nonunion

Nonunion Explanation: Nonunion results from failure of the ends of a fractured bone to unite in normal alignment. Delayed union occurs when there is prolonged healing for union of the fracture. In malunion, there is flawed union of fractured bone. Subluxation is a partial dislocation of the articulating surfaces.

Which of the following terms refers to an injury to ligaments and other soft tissues of a joint? a) Dislocation b) Sprain c) Subluxation d) Strain

Sprain Explanation: A sprain is caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear.

A client sustains an injury to the ligaments surrounding a joint. The nurse identifies this as which of the following? a) Sprain b) Strain c) Contusion d) Fracture

Sprain Explanation: A sprain is an injury to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A contusion is a soft tissue injury resulting from a blow or blunt trauma. A fracture is a break in the continuity of a bone.

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? a) Comminuted b) Compression c) Impacted d) Greenstick

Compound Explanation: A compound fracture is one in which the skin or mucous membrane wound extends to the fractured bone. A complete fracture involves a creak across the entire cross-section of the bone and is frequently displaced. An incomplete fracture involves a break through only part of the cross-section of the bone. A simple fracture is one that does not cause a break in the skin.

Which discharge instruction should a nurse give a client who's had surgery to repair a hip fracture? a) "Don't flex your hip more than 30 degrees, don't cross your legs, and have someone help you put your shoes on." b) "Don't flex your hip more than 90 degrees, don't cross your legs, and have someone help you put your shoes on." c) "Don't flex your hip more than 60 degrees, don't cross your legs, and have someone help you put your shoes on." d) "Don't flex your hip more than 120 degrees, don't cross your legs, and have someone help you put your shoes on."

"Don't flex your hip more than 90 degrees, don't cross your legs, and have someone help you put your shoes on." Explanation: Falls in the home cause most injuries among the elderly. Elderly clients should take measures to decrease the clutter that can contribute to falls, such as removing objects such as throw rugs from the floor. Elderly clients should also install grab bars in the shower and next to the toilet. The threat of fire makes burglar bars on every window impractical.

A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of his activity limitations when he states that he will need to wear the brace for which length of time? a) 6 to 8 weeks b) 14 to 16 weeks c) 2 to 4 weeks d) 10 to 12 weeks

6 to 8 weeks Explanation: Following surgical repair for a ruptured Achilles tendon, the client wears a brace or cast for 6 to 8 weeks.

Two days after surgery to amputate his left lower leg, a client states that he has pain in the missing extremity. Which action by the nurse is most appropriate? a) Administer medication, as ordered, for the reported discomfort. b) Do nothing because it isn't possible to have pain in a missing limb. c) Contact the physician. d) Initiate a consult with a psychologist.

Administer medication, as ordered, for the reported discomfort. Explanation: The sensation of pain and discomfort in an amputated extremity is known as phantom pain. Phantom pain is a normal occurrence after an amputation. It should be treated with medication. The nurse doesn't need to contact the physician at this time. Consultation with the psychologist isn't indicated, and the nurse shouldn't take this action without consulting the physician.

Which assessment findings would cause the nurse to suspect compartment syndrome after casting of the leg? a) Low-grade fever, dyspnea, tachycardia, and crackles b) Complaints of numbness and tingling in toes of affected leg c) Increased capillary refill and bounding pulses in affected leg d) Warm, pink foot and ability to move toes of affected leg

Complaints of numbness and tingling in toes of affected leg Explanation: Numbness and tingling indicate nerve ischemia and edema, suggesting development of compartment syndrome.

Which type of fracture is one in which the skin or mucous membranes extends to the fractured bone? a) Complete b) Compound c) Incomplete d) Simple

Compound Explanation: A compound fracture is one in which the skin or mucous membrane wound extends to the fractured bone. A complete fracture involves a creak across the entire cross-section of the bone and is frequently displaced. An incomplete fracture involves a break through only part of the cross-section of the bone. A simple fracture is one that does not cause a break in the skin.

Which of the following refers to a blunt force injury to soft tissue? a) Strain b) Dislocation c) Contusion d) Fracture

Contusion Explanation: A contusion is blunt force injury to the soft tissue. A dislocation is a separation of joint surfaces. A strain is a musculotendinous injury. A fracture is a break in the continuity of the bone.

A patient was climbing a ladder, slipped on a rung, and fell on the right side of the chest. X-ray studies reveal three rib fractures, and the patient is complaining of pain with inspiration. What is the anticipated treatment for this patient? a) Chest strapping b) Coughing and deep breathing with pillow splinting c) Mechanical ventilation d) Thoracentesis

Coughing and deep breathing with pillow splinting Explanation: Because these fractures cause pain with respiratory effort, the patient tends to decrease respiratory excursions and refrains from coughing. As a result, tracheobronchial secretions are not mobilized, aeration of the lung is diminished, and a predisposition to atelectasis and pneumonia results. To help the patient cough and take deep breaths and use an incentive spirometer (see Chapter 21), the nurse may splint the chest with his or her hands, or may educate the patient on using a pillow to temporarily splint the affected site.

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan? a) Applying heat to the stump as the client desires b) Maintaining the client on complete bed rest c) Elevating the stump for the first 24 hours d) Removing the pressure dressing after the first 8 hours

Elevating the stump for the first 24 hours Explanation: Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. Bed rest isn't indicated and could predispose the client to complications of immobility. Heat application would be inappropriate because it promotes vasodilation, which may cause hemorrhage and increase pain. The initial pressure dressing usually remains in place for 48 to 72 hours after surgery.

A client is brought to the emergency department after injuring his right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean? a) The fracture line extends through the entire bone substance. b) One side of the bone is broken and the other side is bent. c) The fracture results from an underlying bone disorder. d) Bone fragments are separated at the fracture line.

One side of the bone is broken and the other side is bent. Explanation: In a greenstick fracture, one side of the bone is broken and the other side is bent. A greenstick fracture also may refer to an incomplete fracture in which the fracture line extends only partially through the bone substance and doesn't disrupt bone continuity completely. (Other terms for greenstick fracture are willow fracture and hickory-stick fracture.) The fracture line extends through the entire bone substance in a complete fracture. A fracture that results from an underlying bone disorder, such as osteoporosis or a tumor, is a pathologic fracture, which typically occurs with minimal trauma. Bone fragments are separated at the fracture line in a displaced fracture.

Which nursing diagnosis takes highest priority for a client with a compound fracture? a) Risk for infection related to effects of trauma b) Impaired physical mobility related to trauma c) Imbalanced nutrition: Less than body requirements related to immobility d) Activity intolerance related to weight-bearing limitations

Risk for infection related to effects of trauma Explanation: A compound fracture involves an opening in the skin at the fracture site. Because the skin is the body's first line of defense against infection, any skin opening places the client at risk for infection. Imbalanced nutrition: Less than body requirements is rarely associated with fractures. Although Impaired physical mobility and Activity intolerance may be associated with any fracture, these nursing diagnoses don't take precedence because they aren't as life-threatening as infection.

Which laboratory study is most relevant to treating a client who has sustained a pelvic fracture? a) Urine myoglobin b) Serum ethanol c) Type and crossmatch d) Urinalysis

Type and crossmatch Explanation: Because of the rich blood supply to the pelvis, fractures to this area can result in significant blood loss. Type and crossmatch is a priority laboratory test in preparing for fluid replacement. Urine isn't commonly analyzed for myoglobin with this injury unless the mechanism was a crush injury; even then, urinalysis isn't as high a priority as type and crossmatch. Urinalysis and serum ethanol, although part of a trauma workup, aren't relevant to treatment of a pelvic fracture.

A patient falls while skiing and sustains a supracondylar fracture. What does the nurse know is the most serious complication of a supracondylar fracture of the humerus? a) Paresthesia b) Volkmann's ischemic contracture c) Malunion d) Hemarthrosis

Volkmann's ischemic contracture Explanation: The most serious complication of a supracondylar fracture of the humerus is Volkmann contracture (an acute compartment syndrome), which results from antecubital swelling or damage to the brachial artery (Chart 43-3).

A high school student who was injured in a football game presents with knee pain with internal rotation of the foot. Which of the following is an inappropriate nursing intervention? a) Elevate the affected leg. b) Apply ice packs to the affected knee. c) Assist the client to "walk" off the pain. d) Administer morphine sulfate.

Assist the client to "walk" off the pain. Explanation: The client has a torn lateral meniscus. Priority interventions include rest, ice, compression, and elevation of the affected extremity and the administration of NSAIDs for pain.

There are a variety of problems that can become complications after a fracture. Which of the following is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head? a) Fat embolism b) Shock c) Pulmonary embolism d) Avascular necrosis

Avascular necrosis Explanation: Avascular necrosis is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head.

Which of the following is a term used to describe a soft tissue injury produced by a blunt force? a) Strain b) Sprain c) Hematoma d) Contusion

Contusion Explanation: A contusion is a soft tissue injury produced by blunt force, such as a blow, kick, or fall, that results in bleeding into soft tissues (ecchymosis, or bruising). A hematoma develops when the bleeding is sufficient to form an appreciable solid swelling. A strain, or a "pulled muscle," is an injury to a musculotendinous unit caused by overuse, overstretching, or excessive stress. A sprain is an injury to the ligaments and supporting muscle fibers that surround a joint often caused by a trauma, wrenching or twisting motion.

A 13-year-old client is brought to the emergency department. The client's mother reports that the client was struck with a baseball bat on his upper arm while diving for a pitched ball. After diagnostic tests are completed, the physician reassures the mother that her son's humerus is not broken but he has suffered another type of injury. What type of injury would you expect the physician to diagnose? a) Subluxation b) Strain c) Contusion d) Sprain

Contusion Explanation: A contusion is a soft tissue injury resulting from a blow or blunt trauma. Sprains are injuries to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A subluxation is a partial dislocation.

A client presents to the emergency department with an open fracture. What is the first action the nurse should take? a) Assist the physician with reduction of the fracture. b) Assess the client's vital signs and determine allergies. c) Perform a neurovascular assessment of the affected extremity. d) Cover the exposed bone with sterile dressing.

Cover the exposed bone with sterile dressing. Explanation: The exposed bone should be covered with a sterile dressing to protect the deeper tissues from contamination.

Which of the following disorders results in widespread hemorrhage and microthrombosis with ischemia? a) Disseminated intravascular coagulation (DIC) b) Avascular necrosis (AVN) c) Complex regional pain syndrome (CRPS) d) Fat embolism syndrome (FES)

Disseminated intravascular coagulation (DIC) Explanation: DIC is a systemic disorder that results in widespread hemorrhage and microthrombosis with ischemia. AVN of the bone occurs when the bone loses its blood supply and dies. CRPS is a painful sympathetic nervous system problem. FES occurs when the fat globules released when the bone is fractured occludes the small blood vessels that supply the lungs, brain, kidneys, and other organs.

Colles' fracture occurs in which of the following areas? a) Clavicle b) Distal radius c) Elbow d) Humeral shaft

Distal radius Explanation: A Colles' fracture is a fracture of the distal radius (wrist). It is usually the result of a fall on an open, dorsiflexed hand.

Which nursing intervention is appropriate for a patient with a closed reduction extremity fracture? a) Administering prescribed enema to prevent constipation b) Promoting intake of omega-3 fatty acids c) Using frequent dependent positioning to prevent edema d) Encouraging participation in ADLs

Encouraging participation in ADLs Explanation: General nursing measures for a patient with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation with ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the patient for self-care. Omega-3 fatty acids have no implications on the diet of a patient with a fracture reduction. Dependent positioning may increase edema since the extremity is below the level of the heart. While some pain medications may contribute to constipation, this intervention would be reserved for a patient experiencing constipation and not as a preventative measure.

A client with a fracture develops compartment syndrome that requires surgical intervention. The nurse would most likely prepare the client for which of the following? a) Joint replacement b) Amputation c) Bone graft d) Fasciotomy

Fasciotomy Explanation: Surgical treatment of compartment syndrome is achieved with a fasciotomy, a surgical incision of the fascia and separation of the muscle to relieve pressure and restore tissue perfusion. Bone graft, joint replacement or amputation may be done for a client who experiences avascular necrosis.

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing: a) Compartment syndrome b) Complex regional pain sydrome c) Fat embolism syndrome d) Delayed union

Fat embolism syndrome Explanation: The clinical manifestations described in the scenarion are characteristic of fat embolism syndrome.

Which of the following is a factor that inhibits fracture healing? a) Immobilization of the fracture b) Increased vitamin D and calcium in the diet c) Patient age of 35 d) History of diabetes

History of diabetes Explanation: Factors that inhibit fracture healing include diabetes, smoking, local malignancy, bone loss, extensive local trauma, age greater than 40, and infection. Factors that enhance fracture healing include proper nutrition, vitamin D and calcium, exercise, maximum bone fragment contact, proper alignment, and immobilization of the fracture.

When evaluating for hypovolemic shock, the nurse should be aware of which of the following clinical manifestations? a) Bounding pulse b) Hypotension c) Hypertension d) Bradycardia

Hypotension Explanation: The nurse should be alert to a weak pulse (thread), decreased blood pressure, decreased urine output, rapid, shallow respirations, and elevated heart rate.

A 39-year-old softball player has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would you expect the physician to perform? a) Heat and immobilization b) Analgesia and immobilization c) Ice and immobilization d) Joint manipulation and immobilization

Joint manipulation and immobilization Explanation: The physician manipulates the joint or reduces the displaced parts until they return to normal position, then immobilizes the joint with an elastic bandage, cast, or splint for several weeks.

Which of the following is an inaccurate clinical manifestation of a fracture? a) Deformity b) Lengthening c) Pain d) Crepitus

Lengthening Explanation: Clinical manifestations of a fracture include crepitus, deformity pain, shortening, and loss of function.

Which of the following is a factor that inhibits fracture healing? a) Vitamin D b) Exercise c) Maximum bone fragment contact d) Local malignancy

Local malignancy Explanation: Factors that inhibit fracture healing include local malignancy, bone loss, and extensive local trauma. Factors that enhance fracture healing include proper nutrition, vitamin D, exercise, and maximum bone fragment contact.

Which nursing intervention is appropriate for minimizing muscle spasms in the client with a hip fracture? a) Apply a soft compression dressing. b) Maintain the internal fixator. c) Assist the client with use of a trapeze. d) Maintain Buck's traction.

Maintain Buck's traction. Explanation: Buck's traction decreases pain, muscle spasm, and external rotation by immobilizing the hip fracture.

Which intervention should the nurse implement, when caring for the client who complains of phantom limb pain two months after amputation? a) Assess the stump for signs and symptoms of infection. b) Assess the stump for signs and symptoms of bleeding. c) Reassure the client that phantom pain is common. d) Reposition the stump, elevating it on two pillows.

Reassure the client that phantom pain is common. Explanation: The nurse acknowledges the client's complaints of pain.

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include: a) a growth in and around the bone tissue. b) inability to perform active movement and pain with passive movement. c) body-wide decrease in bone mass. d) inability to perform passive movement and pain with active movement.

inability to perform active movement and pain with passive movement. Explanation: With compartment syndrome, the client can't perform active movement, and pain occurs with passive movement. A body-wide decrease in bone mass is seen in osteoporosis. A growth in and around the bone tissue may indicate a bone tumor.

General nursing measures employed when caring for the client with fracture include all of the following, except? a) Providing comfort measures b) Assisting with ADLs c) Cranial nerve assessment d) Administering analgesics

Cranial nerve assessment Explanation: Cranial nerve assessment would only be carried out for head-related injuries or diseases. General nursing measures include administering analgesics, providing comfort measures, assisting with ADLs, preventing constipation, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing client for self-care.

A nurse is inspecting the area of contusion and notes numerous areas of bruising. The nurse would document this finding as which of the following? a) Ecchymosis b) Whiplash injury c) Callus d) Palsy

Ecchymosis Explanation: Bruises due to the rupture of many small blood vessels leads to ecchymoses. Whiplash injury refers to a sprain of the cervical spine. Callus refers to the healing mass that occurs in the bone after a fracture. Palsy refers to decreased sensation and movement

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? a) "Apply ice packs for the first 12 to 18 hours." b) "Apply heat packs for the first 24 to 48 hours." c) "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours." d) "Apply ice packs for the first 24 to 48 hours, then apply heat packs."

"Apply ice packs for the first 24 to 48 hours, then apply heat packs." Explanation: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.

When is it advisable for the nurse to apply heat to a sprain or a contusion? a) Immediately b) Do not apply at all c) Only after a week d) After 2 days

After 2 days Explanation: It is advisable to apply heat on a sprain or a contusion 2 days after a sprain or a contusion has occurred. This is because after 2 days swelling is not likely to increase and as a result heat application reduces pain and relieves local edema by improving circulation. Delaying the application of heat prolongs the pain and increased the risk of local edema.

A client comes to the clinic 2 days after sustaining a sprain to the left ankle. What intervention can the nurse encourage the client to perform that will help improve circulation? a) Take nonsteroidal anti-inflammatory drugs b) Applying heat c) Applying cold compresses d) Active range-of-motion exercises

Applying heat Explanation: After 2 days, when swelling is no longer likely to increase, applying heat reduces pain and relieves local edema by improving circulation. Full use of the injured joint is discouraged temporarily. Nonsteroidal anti-inflammatory drugs will ease discomfort but not improve circulation. Applying cold compresses is only used in the first 24 to 48 hours after an injury to reduce swelling and relieve pain.

The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding? a) Nodules on the knuckles of the third and fourth finger b) Dislocation of the fingers c) Extension of the fingers of the right hand d) Clawlike deformity of the right hand without ability to extend fingers

Clawlike deformity of the right hand without ability to extend fingers Explanation: A Volkmann's contracture is a claw like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. The client is unable to extend the fingers and complains of unrelenting pain, particularly if attempting to stretch the hand. Nodule on the knuckles and dislocation are not indicative of Volkmann's contracture.

There is a table with four columns. Which assessment findings would the nurse expect to find in the postoperative client experiencing fat embolism syndrome? a) Column A b) Column B c) Column C d) Column D

Column B Explanation: Fat embolism syndrome is characterized by fever, tachycardia, tachypnea, and hypoxia. Arterial blood gas findings include a partial pressure of oxygen (PaO2) less than 60 mm Hg, with early respiratory alkalosis and later respiratory acidosis.

A client comes to the emergency department complaining of localized pain and swelling of his lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely? a) Fracture b) Sprain c) Strain d) Contusion

Contusion Explanation: The client's description of blunt trauma by a baseball bat and localized pain in conjunction with swelling and ecchymosis would most likely suggest a contusion. A fracture would be manifested by pain, loss of function, deformity, swelling, and spasm. A sprain would be manifested by pain and swelling; ecchymosis may appear later. A strain is characterized by inflammation, local tenderness, and muscle spasms.

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear? a) Pain worse in the morning b) Minimal pain with movement c) Increased ability to stretch arm over the head d) Difficulty lying on affected side

Difficulty lying on affected side Explanation: Clients with a rotator cuff tear experience pain with movement and limited mobility of the shoulder and arm. They especially have difficulty with activities that involve stretching their arm above their head. Many clients find that the pain is worse at night and that they are unable to sleep on the affected side.

A patient with a right below-the-knee amputation is being transferred from the postanesthesia care unit to a medical-surgical unit. What is the highest priority nursing intervention by the receiving nurse? a) Document the receiving report from the transferring nurse. b) Review the physician orders for type and frequency of ordered pain medication. c) Ensure that a large tourniquet is in the room. d) Delegate the gathering of enough pillows for proper positioning and comfort.

Ensure that a large tourniquet is in the room. Explanation: The patient with an amputation is at risk for hemorrhage. A tourniquet should be placed in plain sight for use if the patient hemorrhages. Documenting the receiving report is important, but is not the highest priority. The nurse may delegate to unlicensed assistive personnel (UAP) the job of gathering more pillows for positioning, but this is not the highest priority. The nurse will need to review the physician's orders for pain medication but, again, this is not the highest priority because any patient is hemorrhaging by the patient needs to be addressed first.

Which of the following terms refers to a fracture in which one side of a bone is broken and the other side is bent? a) Spiral b) Avulsion c) Greenstick d) Oblique

Greenstick Explanation: A greenstick fracture is a fracture in which one side of a bone is broken and the other side is bent. A spiral fracture is a fracture twisting around the shaft of the bone. An avulsion is the pulling away of a fragment of bone by a ligament or tendon and its attachment. An oblique is a fracture occurring at an angle across the bone.

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? a) Thrombophlebitis and infection b) Paralytic ileus and a lacerated urethra c) Hemorrhage and shock d) Paresthesia and ischemia

Hemorrhage and shock Explanation: Hemorrhage and shock are two of the most serious consequences that may occur in a pelvic fracture.

Pulselessness, a very late sign of compartment syndrome, may signify which of the following? a) Nerve involvement b) Venous congestion c) Diminished arterial perfusion d) Lack of distal tissue perfusion

Lack of distal tissue perfusion Explanation: Pulselessness is a very late sign that may signify lack of distal tissue perfusion. The other answers do not apply.

Which of the following terms refers to failure of fragments of a fractured bone to heal together? a) Malunion b) Dislocation c) Subluxation d) Nonunion

Nonunion Explanation: When nonunion occurs, the patient complains of persistent discomfort and movement at the fracture site. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Malunion refers to growth of the fragments of a fractured bone in a faulty position, forming an imperfect union.

The client has suffered a comminuted fracture. Which image best depicts this type of fracture?

Pick the picture where there are several pieces of the bone are broken off. A comminuted fracture (Option A) is a bone that has splintered into several fragments. A fracture in which a bone fragment is driven into another bone fragment is called an impacted fracture (Option B). A transverse fracture (Option C) results in a break straight across the bone shaft. A fracture involving damage to the skin or mucous membranes is called an open or compound fracture (Option D).

A patient with a traumatic amputation of the right lower leg is refusing to look at the leg. Which of the following actions by the nurse is most appropriate? a) Request a referral to occupational therapy. b) Provide feedback on the patient's strengths and available resources. c) Encourage the patient to perform range-of-motion (ROM) exercises to the right leg. d) Provide wound care without discussing the amputation.

Provide feedback on the patient's strengths and available resources. Explanation: The nurse should encourage the patient to look at, and assist with, care of the residual limb. Providing feedback on the patient's strengths and resources may allow the patient to start to adapt to the body image and lifestyle change. The nurse should also allow time for the patient to discuss his or her feelings related to the amputation. Requesting a referral to occupational therapy and encouraging the patient to perform ROM exercises are appropriate, but do not address the emotional aspect of losing an extremity.

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? a) The client complains of pain when the joint is moved and has mild edema. b) The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices. c) The client is unable to bear weight on the left ankle and has a large ecchymotic area. d) The client has ecchymosis, edema, and has no function of the left foot and ankle.

The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices. Explanation: A first-degree strain involves mild stretching of the muscle or tendon, causing some edema and muscle spasm, but no real loss of function. The second-degree strain is partial tearing of muscle or tendon, leading to inability to bear weight and causing edema, muscle tenderness, muscle spasm, and ecchymosis. The third-degree tear is severe muscle and/or tendon tearing, causing severe pain, muscle spasm ecchymosis, edema, and loss of function. A first-degree sprain involves stretching of the ligament fibers characterized by mild edema, tenderness, and pain if the joint is moved.

With fractures of the femoral neck, the leg is a) adducted and internally rotated. b) shortened, abducted, and internally rotated. c) abducted and externally rotated. d) shortened, adducted, and externally rotated.

shortened, adducted, and externally rotated. Explanation: With fractures of the femoral neck, the leg is shortened, adducted, and externally rotated.

A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall? a) Compound fracture b) Transverse fracture c) Pathologic fracture d) Impacted fracture

Pathologic fracture Explanation: A pathologic fracture is a fracture that occurs through an area of diseased bone and can occur without trauma or a fall. An impacted fracture is a fracture in which a bone fragment is driven into another bone fragment. A transverse fracture is a fracture straight across the bone. A compound fracture is a fracture in which damage also involves the skin or mucous membranes.

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? a) "I'll make sure to keep my ankle elevated as much as possible." b) "I'll get the prescription filled for the narcotic pain reliever." c) "I need to stay off my ankle for at least the next 3 to 4 weeks." d) "I'll start with ice for the first couple of hours and then apply heat."

"I'll make sure to keep my ankle elevated as much as possible." Explanation: Treatment consists of applying ice or a chemical cold pack to the area to reduce swelling and relieve pain for the first 24 to 48 hours. Elevation of the part and compression with an elastic bandage also may be recommended. After 2 days, when swelling no longer is likely to increase, applying heat reduces pain and relieves local edema by improving circulation. Full use of the injured joint is discouraged temporarily, not necessarily three to four weeks. Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically recommended; narcotic analgesics typically are not prescribed.

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain? a) Administer prescribed analgesics around-the-clock. b) Administer prescribed pain medication only when the client requests it. c) Give pain medication to the client after providing care. d) Avoid administering too much medication becausethe client is older.

Administer prescribed analgesics around-the-clock. Explanation: Pain associated with hip fracture is severe and must be carefully managed with around-the-clock dosing of pain medication to minimize energy loss in response to pain. The client may not request the medication even if they are in pain, and it should be offered at the prescribed time. Give pain medication prior to providing any type of care involved in moving the client.

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? a) Depressed b) Impacted c) Compound d) Comminuted

Comminuted Explanation: A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment.

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? a) Compound b) Spiral c) Oblique d) Greenstick

Compound Explanation: A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis? a) Volkmann's ischemic contracture b) Infection c) Fat embolism d) Compartment syndrome

Fat embolism Explanation: Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the injury. It occurs when fat droplets released at the fracture site enter the circulation, become lodged in pulmonary capillaries, and break down into fatty acids. Because these acids are toxic to the lung parenchyma, capillary endothelium, and surfactant, the client may develop pulmonary hypertension. Signs and symptoms of fat embolism include an altered mental status, fever, tachypnea, tachycardia, hypoxemia, and petechiae. Compartment syndrome and infection may complicate any fracture and aren't specific to a pelvis fracture. Volkmann's ischemic contracture is a potential complication of a hand or forearm fracture.

A patient suffered an open fracture to the left femur during a horse-riding accident. For which of the following complications is this patient at highest risk? a) Depression b) Complex regional pain syndrome c) Malunion d) Infection

Infection Explanation: This patient is at the highest risk for infection because of the open fracture that was obtained while horseback riding. Infection that enters the body and affects the bone can lead to osteomyelitis. The treatment may involve long-term antibiotics and may even result in fatality. The patient is still at risk for malunion, but this is a slight risk because the bone can be visualized (either through the wound or surgical intervention) and returned to anatomical position. The other options are possible consequences of this type of injury, but do not represent the most serious complication.

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? a) Use measures other than turning to prevent pressure ulcers. b) Keep the hip flexed by placing pillows under the client's knee. c) Prevent internal rotation of the affected leg. d) Keep the affected leg in a position of adduction

Prevent internal rotation of the affected leg. Explanation: The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint. Postoperative total hip replacement clients may be turned onto the unaffected side. The hip may be flexed slightly, but it shouldn't exceed 90 degrees. Maintenance of flexion isn't necessary.

An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as? a) Subluxation b) Volkmann's contracture c) Sprain d) Compartment syndrome

Subluxation Explanation: A partial dislocation is referred to as a subluxation. A Volkmann's contracture is a claw like deformity that results from compartment syndrome or obstructed arterial blood flow to the forearm and hand. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space and affects nerve innervation, leading to subsequent palsy. A sprain is injury to the ligaments surrounding the joint.

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.) a) Wrapping the arm in an ace bandage b) Asking the patient if he or she is able to move the arm c) Immobilizing the affected site d) Covering the area with a clean dressing if the fracture is open e) Splinting the injured limb

• Immobilizing the affected site • Covering the area with a clean dressing if the fracture is open • Splinting the injured limb Explanation: Immediately after injury, if a fracture is suspected, the body part must be immobilized before the patient is moved. Adequate splinting is essential. Joints proximal and distal to the fracture also must be immobilized to prevent movement of fracture fragments. In an upper extremity injury, the arm may be bandaged to the chest, or an injured forearm may be placed in a sling. The neurovascular status distal to the injury should be assessed both before and after splinting to determine the adequacy of peripheral tissue perfusion and nerve function. With an open fracture, the wound is covered with a sterile dressing to prevent contamination of deeper tissues.

When joint manipulation is unsuccessful for a client, he is taken to surgery for surgical repair of his hip injury. He is brought to the ICU where you practice nursing for postoperative recovery. After surgery, the nurse implements measures to prevent complications. Select all of the following which are complications that the nurse seeks to prevent. a) Skin breakdown b) Wound infection c) Diarrhea d) Pneumonia

• Skin breakdown • Wound infection • Pneumonia Explanation: After surgery, the nurse implements measures to prevent skin breakdown, wound infection, pneumonia, constipation, urinary retention, muscle atrophy, and contractures.

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? a) "I'll need to keep several pillows between my legs at night." b) "I don't know if I'll be able to get off that low toilet seat at home by myself." c) "The occupational therapist is showing me how to use a sock puller to help me get dressed." d) "I need to remember not to cross my legs. It's such a habit."

"I don't know if I'll be able to get off that low toilet seat at home by myself." Explanation: The client requires additional teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Teaching the client to avoid crossing the legs also reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees.

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. The nurse would suspect which of the following? a) Avascular necrosis b) Hypovolemic shock c) Pulmonary embolism d) Infection

Avascular necrosis Explanation: Avascular necrosis refers to the death of the bone from insufficient blood supply, typically manifested by complaints of increased pain and decreased function. Fever or redness, purulent drainage, and swelling of the site would suggest infection. Respiratory distress would suggest a pulmonary embolism. Changes in vital signs, level of consciousness, and signs and symptoms of fluid loss would suggest hypovolemic shock.

A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes the patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse understand is likely occurring with this patient? a) Spontaneous pneumothorax b) Pneumonia c) Fat emboli d) Cardiac tamponade

Fat emboli Explanation: After fracture of long bones or pelvic bones, or crush injuries, fat emboli frequently form. Fat embolism syndrome (FES) occurs when fat emboli cause morbid clinical manifestations. The classic triad of clinical manifestations of FES include hypoxemia, neurologic compromise, and a petechial rash (NAON, 2007), although not all signs and symptoms manifest at the same time (Tzioupis & Giannoudis, 2011). The typical first manifestations are pulmonary and include hypoxia and tachypnea.

A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? a) Turning the client from side to side every 2 hours b) Maintaining the client in semi-Fowler's position c) Performing passive range-of-motion (ROM) exercises on the client's legs once each shift d) Keeping a pillow between the client's legs at all times

Keeping a pillow between the client's legs at all times Explanation: After hip pinning, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After hip pinning, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.

Which nursing intervention is essential in caring for a client with compartment syndrome? a) Keeping the affected extremity below the level of the heart b) Removing all external sources of pressure, such as clothing and jewelry c) Wrapping the affected extremity with a compression dressing to help decrease the swelling d) Starting an I.V. line in the affected extremity in anticipation of venogram studies

Removing all external sources of pressure, such as clothing and jewelry Explanation: Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity.

Which of the following may occur if a client experiences compartment syndrome in an upper extremity? a) Callus b) Whiplash injury c) Volkmann's contracture d) Subluxation

Volkmann's contracture Explanation: If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a clawlike deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation.

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? a) With the affected hip rotated externally b) With the leg on the affected side abducted c) With the leg on the affected side adducted d) With the affected hip flexed acutely

With the leg on the affected side abducted Explanation: The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint.

Sarah Butler, age 26 years, has been participating in a tennis tournament. She is being seen in the clinic for elbow discomfort. The physician has given her a diagnosis of tendinitis, epicondylitis, or tennis elbow. What symptoms and signs did she have? Choose all that are correct. a) Pain or burning in one or both hands b) Pain more prominent at night c) Weak grasp d) Pain radiating down the dorsal surface of the forearm

• Pain radiating down the dorsal surface of the forearm • Weak grasp Explanation: Tennis elbow is characterized by pain radiating down the dorsal surface of the forearm and weak grasp. Carpal tunnel syndrome is characterized by pain or burning in one or both hands and pain more prominent at night.