Musculoskeletal Trauma and Orthopedic Surgery

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

A

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

A

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

A

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

A

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

A

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

B

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

B

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

B

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

B

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

B

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

B

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

C

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

C

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

C

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

C

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

C

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

C

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

D