Chapter 61 MS

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? A) Blood pressure of 140/90 mm Hg B) Crackles in the lung bases C) Client complains of pain in the affected rib area when taking a deep breath D) Heart rate of 94 beats/minute

B) Crackles in the lung bases

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? A) Cutting of a bivalve cast B) Cutting a cast window C) Removal of the cast D) Insertion of an external fixator

B) Cutting a cast window

A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. The nurse identifies this as which type of cast? A) Short arm cast B) Gauntlet cast C) Body cast D) Spica cast

B) Gauntlet cast

A client has just undergone a leg amputation. The nurse would closely monitor the client for which of the following during the immediate postoperative period? A) Neuroma B) Hematoma C) Chronic osteomyelitis D) Unexplainable burning pain (causalgia)

B) Hematoma

A client is scheduled for a joint replacement surgery. Which action would be most important? A) Ensure adequate fluid intake before the surgery. B) Withhold intake of solid food before the surgery. C) Withhold administration of aspirin before the surgery. D) Ensure adequate sleep before the surgery.

C) Withhold administration of aspirin before the surgery.

A client in skeletal traction has a nursing diagnosis of Impaired Tissue Integrity: Related to puncture wound; pins. What expected outcome would be appropriate for this client? A) Assess pin sites daily. B) Client will maintain maximum self-care. C) Wounds heal without infection. D) Clean the pin sites with prescribed cleaning solution.

C) Wounds heal without infection.

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? A. Consult a skin specialist. B. Scrub the area vigorously to remove the crust. C. Apply lotions and take warm baths or soaks. D. Avoid exposure to direct sunlight.

C. Apply lotions and take warm baths or soaks.

A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client? A) Advising the client to avoid red meat B) Urging her to keep the affected limb in an elevated position C) Educating the client about the effects of menopause D) Exploring factors related to the client's home environment

D) Exploring factors related to the client's home environment

The nurse is preparing a client for a hip replacement with the use of porous-coated cementless joint components. What does the nurse know is the benefit of this type of component? A) The component is less expensive because there is no cement used. B) The client will not reject the prosthesis because there is no cement on the prosthetics. C) It prevents the client from developing infection related to the application of cement in the joint spaces. D) It allows the bone to grow into the prosthesis and securely fix the joint replacement in place.

D) It allows the bone to grow into the prosthesis and securely fix the joint replacement in place.

The nurse is caring for a client who had a surgical amputation of the left leg related to complication from diabetes. The client asks the nurse, "If my leg is really gone, then why am I having such bad pain?" What is the best response by the nurse? A) "You are only imagining that you are having pain." B) "It is called phantom pain and may come and go." C) "You will continue to have this pain, and you will have to learn to ignore it." D) "This is called false pain and is a brain dysfunction."

B) "It is called phantom pain and may come and go."

A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse? A) "We will need to monitor the status of the laceration to be sure it does not get infected." B) "The arm does not require the same immobilization that a leg fracture would." C) "You will be able to wear the splint longer than you would a cast." D) "The splint is less expensive than the cast."

A) "We will need to monitor the status of the laceration to be sure it does not get infected."

A client is scheduled for a total left knee arthroplasty in 2 weeks. When would the best time for postoperative nursing management begin? A) Before surgery B) When the client is taken to the postanesthesia care unit C) After the client returns to the room after surgery and receives pain medication D) Twenty-four hours after the procedure

A) Before surgery

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? A) Better molding to the client B) Quicker drying C) Longer lasting D) More breathable

A) Better molding to the client

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? A) Call the physician to inform them of the findings. B) Administer pain medication. C) Request an antihistamine for the allergic reaction. D) Increase the intravenous fluids for hemorrhage.

A) Call the physician to inform them of the findings.

A client had a surgical amputation of an arm and is having a myoelectric arm applied. What does the nurse understand are the benefits of this type of device? SATA A) Eliminates the need to wear a harness B) Terminal device looks natural C) Better function than cosmetic hand D) Stronger than other devices E) Lasts longer than other devices

A) Eliminates the need to wear a harness B) Terminal device looks natural C) Better function than cosmetic hand

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? A) Left hip arthroplasty B) Left hip arthroscopy C) Open reduction and internal fixation of the left hip. D) Closed reduction of the left hip.

A) Left hip arthroplasty

The nurse is caring for a client in traction that is immobile. What measures can the nurse provide to prevent further injury and potential infection and promote circulation to the area? A) Massage bony prominences subject to pressure unless red when pressure relieved. B) Massage all reddened bony prominences to increase the circulation to the area. C) Rub alcohol into the skin three times a day to make the skin tougher and less prone to breakdown. D) Administer protein supplements to the client to avoid the breakdown associated with malnourishment.

A) Massage bony prominences subject to pressure unless red when pressure relieved.

During the assessment of a client scheduled for orthopedic surgery, the nurse discovers that the client was previously treated for the disorder. In such a case, what additional data need to be collected? A) Occurrence of complications or problems during treatment B) Measures taken to minimize postoperative wound infection C) Perception of the client about the previous treatment D) Details of the medical team that handled the previous treatment

A) Occurrence of complications or problems during treatment

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? A) Short leg cast B) Long leg cast C) Walking cast D) Hip spica cast

A) Short leg cast

A client has a fractured jaw sustained in an automobile accident and has had the fracture surgically reduced and immobilized with a wire loop. What should the nurse ensure is present at the client's bedside in case of vomiting? A) Wire cutters B) A tracheostomy tray C) Ice water with a straw D) An antiemetic medication

A) Wire cutters

A client was playing softball and dislocated four of his fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as? A) Open reduction B) Closed reduction C) Open reduction with internal fixation D) External fixation

B) Closed reduction

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? SATA A) Surgery will not be required. B) Muscle spasms will be relieved. C) The bones of the left leg will be aligned. D) Immobilization of the left leg will be maintained. E) Less pain medication will be required.

B) Muscle spasms will be relieved. C) The bones of the left leg will be aligned. D) Immobilization of the left leg will be maintained.

The nurse is caring for a client with an external fixator that requires pin care twice a day. The nurse observes that there is a new purulent drainage around one of the pins. What intervention should the nurse anticipate doing? A) Scrubbing the drainage from around the pin site B) Obtaining a culture C) Applying iodine-based solution D) Apply ointment to the pin site.

B) Obtaining a culture

The nurse is caring for a patient with a fractured right femur who is not a candidate to repair the femur immediately. What intervention should the nurse anticipate the physician will order to relieve muscle spasm and pain until surgery is performed? A) Skeletal traction B) Skin traction C) Open reduction D) External fixator

B) Skin traction

When performing pin care, which of the following would be most appropriate? SATA A) Clean the site, working toward the pin. B) Use an applicator only once. C) Gently remove crusts around pin sites. D) Apply an antimicrobial ointment.

B) Use an applicator only once. C) Gently remove crusts around pin sites.

A patient is scheduled for hip replacement surgery in a month. Which statement made by the client demonstrates understanding for the preoperative instructions? A. "I will stop taking my antihypertensive medications prior to my surgery." B. "I will stop taking my aspirin prior to my surgery." C. "I will have heat packs applied to my hip immediately after surgery." D. "I will be able to walk independently when I wake up from surgery."

B. "I will stop taking my aspirin prior to my surgery."

The nurse is caring for a client who had an amputation of the left leg above the knee. What position can the nurse place the client in several times per day to promote stump extension and prevent contractures? A) Supine B) Left lateral C) Prone D) Right lateral

C) Prone

Which of the following would the nurse expect a physician to use on a short-term basis for a client with an injured body part that does not require rigid immobilization? A) Cast B) Brace C) Splint D) Skin traction

C) Splint

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fracture tibia. What should the nurse inform the client prior to the cast being removed? A) The leg will look as it did prior to the cast being applied. B) The leg will look moist and will have small bumps that will go away in a few days. C) The skin may be covered with a yellowish crust that will shed in a few days. D) The leg strength is enforced by the wearing of the cast.

C) The skin may be covered with a yellowish crust that will shed in a few days.

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? A) Arthrodesis B) Hemiarthroplasty C) Total arthroplasty D) Osteotomy

C) Total arthroplasty

A client has had a knee replacement and will be discharged in the morning. What does the nurse understand the goal for bending the knee is by discharge? A) 15° B) 30° C) 60° D) 90°

D) 90°

The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery? A) Antidysrhythmia therapy B) Antianginal therapy C) Antineoplastic therapy D) Anticoagulation therapy

D) Anticoagulation therapy

A client sustained a stable fracture of the cervical spine and is having skeletal traction applied. What type of traction does the nurse educate the client about? A) Kirschner wires B) Thomas splint C) Steinmann pins D) Crutchfield tongs

D) Crutchfield tongs

A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize? A) Client complains of tingling and numbness in the right shoulder. B) Right shoulder is elevated above the left. C) Client complains of pain in the unaffected shoulder. D) Right shoulder slopes downward and droops inward.

D) Right shoulder slopes downward and droops inward.

The nurse is caring for a client who has had a fracture reduction using a cast. Which of the following would be most important for the nurse to assess? A. Cardiac and respiratory status B. Renal and hepatic function C. Sleep status D. Sensation and mobility status

D. Sensation and mobility status