PrepU quizzes

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? -Atelectasis -Hypovolemia -Pulmonary embolism -Urinary tract infection

-Pulmonary embolism Patients having orthopedic surgery are particularly at risk for venous thromboembolism, including deep vein thrombosis and pulmonary embolism.

Which of the following is the most appropriate nursing intervention to facilitate healing in a patient who has suffered a hip fracture? A) Administer analgesics as required. B) Place a pillow between the patients legs when turning. C) Maintain prone positioning at all times. D) Encourage internal and external rotation of the affected leg.

B

A clinic nurse is caring for a patient with a history of osteoporosis. Which of the following diagnostic tests best allows the care team to assess the patients risk of fracture? A) Arthrography B) Bone scan C) Bone densitometry D) Arthroscopy

C

The nurse is preparing the client with a right neck mass for magnetic resonance imaging (MRI). Which question should the nurse ask? Select all that apply. - "Do you have a pacemaker?" - "Have you removed your hearing aid?" - "When is the last time you had food or drink?" - "Did you take your medications this morning?" - "Are you wearing any jewelry?"

- "Do you have a pacemaker?" - "Have you removed your hearing aid?" - "Are you wearing any jewelry?"

A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client? -Assisting with range-of-motion and isometric exercises. -Changing the client's position within prescribed limits. -Administering prescribed analgesics. -Applying warm compresses.

-Changing the client's position within prescribed limits. Changing the position of a client within prescribed limits helps relieve pressure on bony areas and promotes comfort. Analgesics help to relive pain but may not help relieve pressure on bony areas. Warm compresses aid blood circulation. The client should not exercise while on traction unless prescribed to regain strength in the affected limb.

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.) -Decreased sensory function -Excruciating pain -Loss of motion -Capillary refill less than 3 seconds -2+ peripheral pulses in the affected distal pulse

-Decreased sensory function -Excruciating pain -Loss of motion Clinical manifestations include dusky, pale appearance of the exposed extremity; cool skin temperature; delayed capillary refill; paresthesia; and unrelenting pain not relieved by position changes, ice, or analgesia. A hallmark sign is pain that occurs or intensifies with passive range of motion (Johnston-Walker & Hardcastle, 2011). The patient may complain that the cast, brace, or splint is too tight. The primary provider must be notified immediately.

A patient arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the patient to describe the pain? -Similar to "muscle cramps" -Sharp and piercing -Sore and aching -A dull, deep, boring ache

-Sharp and piercing

Which is an inaccurate principle of traction? -The weights are not removed unless intermittent treatment is prescribed. -The weights must hang freely. -The client must be in good alignment in the center of the bed. -Skeletal traction is interrupted to turn and reposition the client.

-Skeletal traction is interrupted to turn and reposition the client. Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely, with the client in good alignment in the center of the bed.

A nurse who oversees care in a long-term care facility is aware that a high percentage of residents have osteoporosis, and that residents who do not have the disease must be assessed and monitored closely for this health problem. Which of the following older adults most clearly exemplifies the risk factors for osteoporosis? 1- A Caucasian woman who has low body mass index 2- An African American woman who is slightly obese 3- An Asian man whose mobility is limited to a wheelchair 4- A Caucasian man who has led a sedentary lifestyle

1- A Caucasian woman who has low body mass index

A patient has sustained a long bone fracture and the nurse is preparing the patients care plan. Which of the following should the nurse include in the care plan? A) Administer vitamin D and calcium supplements as ordered. B) Monitor temperature and pulses of the affected extremity. C) Perform passive range of motion exercises as tolerated. D) Administer corticosteroids as ordered.

B

A patient has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing his ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have contributed to this complication? A) Inadequate vitamin D intake B) Bleeding at the injury site C) Inadequate immobilization D) Venous thromboembolism (VTE)

C

Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? A Risk for constipation related to immobility B Deficient knowledge about osteoporosis and the treatment regimen C Acute pain related to fracture and muscle spasm D Risk for injury related to fractures due to osteoporosis

D The most important concern for an elderly patient with osteoporosis is prevention of falls and fractures. Pain and constipation can be managed, and knowledge can be reinforced, but fractures can cause significant morbidity and mortality.

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching? - "I may notice some bruising or swelling in my knee." - "My physician may prescribe pain pills after the procedure." - "Elevating my leg will reduce swelling after the procedure." - "I should use my heating pad this evening to reduce some of the pain in my knee."

- "I should use my heating pad this evening to reduce some of the pain in my knee."

The older client asks the nurse how best to maintain strong bones. What is the nurse's best response? - "Weight-bearing exercises can strengthen bones." - "Cardio-training is the best way to build bones." - "Weight-resistance exercises can strengthen bones." - "Range of motion exercises build bone mass."

- "Weight-bearing exercises can strengthen bones."

The nurse is performing a neurovascular assessment of a client's injured extremity. Which would the nurse report? - Dusky or mottled skin color - Positive distal pulses - Capillary refill of 3 seconds - Skin warm to touch

- Dusky or mottled skin color

The nurse is conducting a medication reconciliation with a client admitted with a fracture. What medication predisposes a client for a risk for fractures? - furosemide - digoxin - prednisone - metoprolol

- prednisone

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide? -"Limit hip flexion to 90 degrees." -"Perform rotation exercises each day." -"Intermittently cross and uncross your legs several times each day." -"Avoid weight bearing until the hip is completely healed."

-"Limit hip flexion to 90 degrees." The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. The hip should not bend more than 90 degrees. Ambulation begins the day following surgery, and weight bearing ambulation may not be restricted, depending on the type of prosthesis.

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? -An open reduction -A fasciotomy -A total hip replacement -A total knee replacement

-A fasciotomy A treatment option for compartment snydrome is fasciotomy.

A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction? -Crutchfield tongs -Thomas splint -Buck's -Balanced suspension

-Buck's An example of skin traction is Buck's traction. Crutchfield tongs, a Thomas splint, or balanced suspension traction are types of skeletal traction.

Which intervention should the nurse implement with the client who has undergone a hip replacement? -Instruct the client to avoid internal rotation of the leg. -Place the client in high Fowler's position for meals. -Have the client bend forward to rise from the chair. -Adduct the legs by placing a pillow between the legs.

-Instruct the client to avoid internal rotation of the leg. The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. A pillow is used to keep the legs in abduction. The hip should not bend more than 90 degrees when seated. The head of bed should be kept at 60 degrees or less.

A client has undergone an external fixation. Which actions would be the priority for this client? -Maintaining pin care. -Planning the client's diet. -Monitoring the client's urine output. -Monitoring the client's blood pressure.

-Maintaining pin care. Pin care is a priority for a client with external fixation, because pin sites are entry points for infection. The nurse should also monitor redness, drainage, and tenderness at the site. Planning the client's diet and monitoring the client's urine output and blood pressure, although necessary, are not as important as maintaining pin care.

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? -Buck's traction -Skeletal traction -Internal fixation -Open reduction

-Open reduction In an open reduction, the bone is surgically exposed and realigned. Buck's traction is a type of skin traction that provides pulling on the structures. Skeletal traction is applied directly to the bone using a wire, pin, or cranial tongs. Internal fixation involves the use of metal screws, plates, rods, nails or pins to stabilize a reduced fracture.

Which of the following inhibits bone resorption and promotes bone formation? 1- Calcitonin 2- Estrogen 3- Parathyroid hormone 4- Corticosteroids

1- Calcitonin Explanation: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging.

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate? 1- Yoga 2- Walking 3- Bicycling 4- Swimming

2

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? 1- Increase fiber in the diet 2- Walk or perform weight-bearing exercises outdoors 3- Reduce stress 4- Decrease the intake of vitamin A and D

2

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? 1- Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. 2- To prevent fractures, the client should avoid strenuous exercise. 3- The recommended daily allowance of calcium may be found in a wide variety of foods. 4- Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.

3

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? 1- Bone spurs 2- Diarrhea 3- Increased heel pain 4- Decreased height

4

Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? 1- Deficient knowledge about osteoporosis and the treatment regimen 2- Acute pain related to fracture and muscle spasm 3- Risk for constipation related to immobility 4- Risk for injury related to fractures due to osteoporosis

4

A patients fracture is healing and callus is being deposited in the bone matrix. This process characterizes what phase of the bone healing process? A) The reparative phase B) The reactive phase C) The remodeling phase D) The revascularization phase

A

Diagnostic tests show that a patients bone density has decreased over the past several years. The patient asks the nurse what factors contribute to bone density decreasing. What would be the nurses best response? A) For many people, lack of nutrition can cause a loss of bone density. B) Progressive loss of bone density is mostly related to your genes. C) Stress is known to have many unhealthy effects, including reduced bone density. D) Bone density decreases with age, but scientists are not exactly sure why this is the case.

A

The nurse is assessing a patient for dietary factors that may influence her risk for osteoporosis. The nurse should question the patient about her intake of what nutrients? Select all that apply. A) Calcium B) Simple carbohydrates C) Vitamin D D) Protein E) Soluble fiber

A, C

A nurse admits a patient who has a fracture of the nose that has resulted in a skin tear and involvement of the mucous membranes of the nasal passages. The orthopedic nurse is aware that this description likely indicates which type of fracture? A) Compression B) Compound C) Impacted D) Transverse

B

A nurse is assessing a patient who is experiencing peripheral neurovascular dysfunction. What assessment findings are most consistent with this diagnosis? A) Hot skin with a capillary refill of 1 to 2 seconds B) Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin C) Pain, diaphoresis, and erythema D) Jaundiced skin, weakness, and capillary refill of 3 seconds

B

A nurse is performing a shift assessment on an elderly patient who is recovering after surgery for a hip fracture. The nurse notes that the patient is complaining of chest pain, has an increased heart rate, and increased respiratory rate. The nurse further notes that the patient is febrile and hypoxic, coughing, and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this patient is likely demonstrating symptoms of what complication? A) Avascular necrosis of bone B) Compartment syndrome C) Fat embolism syndrome D) Complex regional pain syndrome

C

An older adult patient has come to the clinic for a regular check-up. The nurses initial inspection reveals an increased thoracic curvature of the patients spine. The nurse should document the presence of which of the following? A) Scoliosis B) Epiphyses C) Lordosis D) Kyphosis

D

Radiographs of a boys upper arm show that the humerus appears to be fractured on one side and slightly bent on the other. This diagnostic result suggests what type of fracture? A) Impacted B) Compound C) Compression D) Greenstick

D

The nurse teaches the patient which of the following interventions in order to avoid hip dislocation after replacement surgery? a) Keep the knees together at all times b) Never cross the affected leg when seated c) Bend forward only when seated in a chair d) Avoid placing a pillow between the legs when sleeping

Never cross the affected leg when seated Explanation: Crossing the affected leg may result in dislocation of the hip joint after total hip replacement. The patient should be taught to keep the knees apart at all times. The patient should be taught to put a pillow between the legs when sleeping. The patient should be taught to avoid bending forward

Which statement describes paresthesia? - Abnormal sensations - Absence of muscle tone - Involuntary twitch of muscle fibers - Absence of muscle movement suggesting nerve damage

- Abnormal sensations

During a general musculoskeletal assessment, what would help the nurse determine the client's muscle strength? - Asking the client to lift specified amounts of weights. - Applying force to the client's extremity as the client pushes against that force. - Examining extremities for symmetry, size, and contour. - Palpating each of the client's muscles and joints.

- Applying force to the client's extremity as the client pushes against that force.

The nurse is performing a neurological assessment. What will this assessment include? - Inspect the foot for edema. - Observe for capillary refill of the great toe. - Ask the client to plantar flex the toes. - Palpate the dorsalis pedis pulse.

- Ask the client to plantar flex the toes.

Which is an indicator of neurovascular compromise? - Warm skin temperature - Capillary refill of more than 3 seconds - Pain upon active stretch - Diminished pain

- Capillary refill of more than 3 seconds

Which action would be most important postoperatively for a client who has had a knee or hip replacement? -Providing crutches to the client. -Assisting in early ambulation. -Using a continuous passive motion (CPM) machine. -Encouraging expressions of anxiety.

-Assisting in early ambulation. An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement. A CPM machine or crutches may be provided when prescribed. It is important to encourage clients to express their feelings of anxiety or depression. This is more crucial for clients who undergo an amputation rather than for clients who undergo a replacement surgery.

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? -Elevate the affected extremity and use cold applications. -Breathe deeply and cough every 2 hours until ambulation is possible. -Do ROM exercises as indicated. -Apply antiembolism stockings as indicated.

-Elevate the affected extremity and use cold applications. Elevating the affected extremity and using cold applications reduce swelling. Deep breathing and coughing helps with maintenance of effective respiratory rate and depth. ROM exercises maintain full ROM of unaffected joints. Antiembolism stockings help prevent deep vein thrombosis (DVT).

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? -Advising the client to avoid red meat -Urging her to keep the affected limb in an elevated position -Educating the client about the effects of menopause -Exploring factors related to the client's home environment

-Exploring factors related to the client's home environment Exploring factors related to the older adult client's home environment and determining a plan for continued rehabilitation before discharge is most important. The client should be encouraged to eat foods rich in protein, calcium, and vitamin D. Because the healing is almost complete, the client need not always keep the affected limb elevated unless prescribed to do so. Because the client is in her late 60s, she is most likely to have already undergone menopause. Therefore, educating her about the effects of menopause is not as important.

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? -It provides active range of motion. -It promotes healing by increasing circulation and movement of the knee joint. -It promotes healing by immobilizing the knee joint. -It prevents infection and controls edema and bleeding.

-It promotes healing by increasing circulation and movement of the knee joint. A CPM device applied after knee surgery promotes healing by increasing circulation and movement of the knee joint.

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? -Body aligned opposite to line of traction pull -Weights hanging and touching the floor -Pulleys without evidence of the obstruction -Ropes freely moving over pulleys

-Weights hanging and touching the floor When checking traction equipment, the weights should be freely hanging. Weights that touch the floor require the nurse to intervene. The body should be aligned in an opposite line to the pull of the traction. The ropes should be freely moving over unobstructed pulleys.

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? 1- "I will lie prone with my legs slightly elevated." 2- "I will bend at the waist when I am lifting objects from the floor." 3- "I will avoid prolonged sitting or walking." 4- "Instead of turning around to grasp an object, I will twist at the waist."

3

The nurse is performing an assessment of a patients musculoskeletal system and is appraising the patients bone integrity. What action should the nurse perform during this phase of assessment? A) Compare parts of the body symmetrically. B) Assess extremities when in motion rather than at rest. C) Percuss as many joints as are accessible. D) Administer analgesia 30 to 60 minutes before assessment.

A

A nurse is planning the care of a middle-aged female patient whose sedentary lifestyle has contributed to ongoing problems with lower back pain. The nurse should recognize which of the following interventions as holding the potential for adequate and long-lasting pain control? A Weight loss B Use of a back brace C Antiseizure medications D Orthopedic footwear

A Weight loss

A young patient is being treated for a femoral fracture suffered in a snowboarding accident. The nurses most recent assessment reveals that the patient is uncharacteristically confused. What diagnostic test should be performed on this patient? A) Electrolyte assessment B) Electrocardiogram C) Arterial blood gases D) Abdominal ultrasound

C

A patient has had a cast placed for the treatment of a humeral fracture. The nurses most recent assessment shows signs and symptoms of compartment syndrome. What is the nurses most appropriate action? A) Arrange for a STAT assessment of the patients serum calcium levels. B) Perform active range of motion exercises. C) Assess the patients joint function symmetrically. D) Contact the primary care provider immediately.

D

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which of the following complications? a) Dislocation of the hip b) Avascular necrosis of the hip c) Re-fracture of the hip d) Contracture of the hip

Dislocation of the hip Explanation: Manifestations of a dislocated hip prosthesis are increased pain at the surgical site, acute groin pain in the affected leg, shortening of the leg, abnormal external or internal rotation, and limited movement of the fractured leg. The client may report a "popping" sensation in the hip.

Which clinical manifestation would the nurse recognize as an indicator of peripheral neurovascular dysfunction? Select all that apply. - Complaints of pins and needles in feet - Capillary refill less than 3 seconds - Absence of pain - Toes mottled and cool - Dorsiplantar flexion strong

- Complaints of pins and needles in feet - Toes mottled and cool

Which assessment finding would cause the nurse to suspect compartment syndrome in the client following a bone biopsy? - Toes move freely without pain - Capillary refill < 3 seconds - Bounding dorsalis pedis pulses - Increased diameter of the calf

- Increased diameter of the calf

The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as? - Osteoporosis - Lordosis - Scoliosis - Kyphosis

- Kyphosis

The nurse is employed at a long-term care facility caring for geriatric clients. Which assessment finding is characteristic of an age-related change? - Cognitive decline - Loss of height - Increased muscle mass - Depressive symptoms

- Loss of height

A nurse knows that a person with a 3-week-old femur fracture is at the stage where angiogenesis is occurring. What are the characteristics of this stage? - New capillaries producing a bridge between the fractured bones. - Inflammation and the stimulation of osteoblasts and osteoclasts. - The formation of a hematoma and fibrin. - Cartilage cells forming matrix villa that regulate calcification of the cartilage.

- New capillaries producing a bridge between the fractured bones.

A patient comes to the clinic and informs the nurse of numbness, tingling, and a burning sensation in the arm from the elbow down to the fingers. What type of symptom would this be documented as? - Effusion - Paresthesia - Flaccidity - Atonia

- Paresthesia

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) -"You may cross your legs at the ankles only." -"Place pillows between your legs when you lay on your side." -"Avoid bending forward when sitting in a chair." -"Use a raised toilet seat and high-seated chair." -"It is okay to briefly flex the hip to put on your clothes."

-"Place pillows between your legs when you lay on your side." -"Avoid bending forward when sitting in a chair." -"Use a raised toilet seat and high-seated chair." The client following post hip replacement should not cross the legs, even at the ankle. He or she should avoid bending forward when sitting in a chair, avoid flexing the hip when dressing, and use a raised toilet seat. A pillow should be placed between the legs when side-lying.

Which nursing action would help prevent deep vein thrombosis in a client who has had an orthopedic surgery? -Instruct about using client-controlled analgesia, if prescribed -Instruct about exercise, as prescribed -Apply antiembolism stockings -Apply cold packs

-Apply antiembolism stockings Applying antiembolism stockings helps prevent deep vein thrombosis (DVT) in a client who is immobilized due to orthopedic surgery. Regular administration of analgesics controls and prevents escalation of pain, while ROM exercises help maintain muscle strength and tone and prevent contractions. On the other hand, cold packs are applied to help reduce swelling; cold does not prevent deep vein thrombosis.

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan? -Keeping the casted arm warm by covering it with a light blanket -Avoiding handling the cast for 24 hours or until it is dry -Evaluating pedal and posterior tibial pulses every 2 hours -Assessing movement and sensation in the fingers of the right hand

-Assessing movement and sensation in the fingers of the right hand The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting circulation. To reduce the risk of skin breakdown, the nurse should leave a casted arm uncovered, which allows air to circulate through the cast pores to the skin below. Unlike a plaster cast, a Fiberglass cast dries quickly and can be handled without damage soon after application. The nurse should assess the brachial and radial pulses distal to the cast — not the pedal and posterior tibial pulses, which are found in the legs.

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

-Left hip arthroplasty Clients with arthritis, trauma, hip fracture, or a congenital deformity may have an arthroplasty, or reconstruction of the joint. This procedure uses an artificial joint that restores previously lost function and relieves pain. An arthroscopy is not used to reconstruct a diseased hip. A closed reduction is not an invasive surgical procedure and would not be used to reconstruct the hip. An open reduction and internal fixation is not the treatment for reconstruction of the hip related to a diseased hip.

The nurse assesses a clientafter total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. What is the priority action of the nurse? -Apply Buck's traction. -Notify the health care provider. -Externally rotate the extremity. -Bend the knee and rotate the knee internally.

-Notify the health care provider. If any clinical manifestations of dislocation of the prosthesis occur, including acute groin pain in the affected hip or shortening of the affected extremity, the nurse (or the client, if at home) must immediately notify the surgeon, because the hip must be reduced and stabilized promptly so that the leg does not sustain circulatory and nerve damage. After closed reduction, the hip may be stabilized with Buck's traction or a brace to prevent recurrent dislocation. As the muscles and joint capsule heal, the chance of dislocation diminishes. Stresses to the new hip joint should be avoided for the first 8 to 12 weeks, when the risk of dislocation is greatest.

Which actions by the nurse demonstrate an understanding of caring for a client in traction? Select all that apply. -Placing a trapeze on the bed -Ensuring that the weights are hanging freely -Assessing the client's alignment in the bed -Removing skeletal traction to turn and reposition the client -Frequently assessing pain level

-Placing a trapeze on the bed -Ensuring that the weights are hanging freely -Assessing the client's alignment in the bed -Frequently assessing pain level The weights must hang freely, with the client in good alignment in the center of the bed. The nurse should frequently monitor pain, as uncontrolled pain may be a sign of a complication. The client will be able to assist with alignment and bed mobility if a trapeze is placed on the bed. Skeletal traction should never be interrupted.

Which principle applies to the client in traction? -Weights should rest on the bed. -Skeletal traction is never interrupted. -Knots in the ropes should touch the pulley. -Weights are removed routinely.

-Skeletal traction is never interrupted. Skeletal traction is applied directly to the bone and is never interrupted. To be effective, the weights must hang freely and not rest on the bed or floor. Knots in the rope or the footplate must not touch the pulley or the foot of the bed. Traction must be continuous to be effective in reducing and immobilizing fractures.

Which is not a guideline for avoiding hip dislocation after replacement surgery. -The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. -Keep the knees apart at all times. -Put a pillow between the legs when sleeping. -Never cross the legs when seated.

-The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. Guidelines for avoiding hip dislocation after replacement surgery specify that the hip should not be flexed to put on clothing such as pants, stockings, socks, or shoes. Clients should keep the knees apart at all times, put a pillow between the legs when sleeping, and never cross the legs when seated.

During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? 1- "After age 40, height may show a gradual decrease as a result of spinal compression" 2- "After menopause, the body's bone density declines, resulting in a gradual loss of height." 3- "There may be some slight discrepancy between the measuring tools used." 4- "The posture begins to stoop after middle age."

2- "After menopause, the body's bone density declines, resulting in a gradual loss of height."

An older adult patient has fallen in her home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning assessments during the patients presurgical care, the nurse should be aware of the patients heightened risk of what complication? A) Osteomyelitis B) Avascular necrosis C) Phantom pain D) Septicemia

B

A nurse is taking a health history on a new patient who has been experiencing unexplained paresthesia. What question should guide the nurses assessment of the patients altered sensations? A) How does the strength in the affected extremity compare to the strength in the unaffected extremity? B) Does the color in the affected extremity match the color in the unaffected extremity? C) How does the feeling in the affected extremity compare with the feeling in the unaffected extremity? D) Does the patient have a family history of paresthesia or other forms of altered sensation?

C

A patient is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The patient has been placed in traction until his femur can be rodded in surgery. For what early complications should the nurse monitor this patient? Select all that apply. A) Systemic infection B) Complex regional pain syndrome C) Deep vein thrombosis D) Compartment syndrome E) Fat embolism

C, D, E

A patient has a fracture of the right femur sustained in an automobile accident. What process of fracture healing does the nurse understand will occur with this patient? - Reactive phase, reparative phase, remodeling phase - First intention, secondary intention, third intention - Active phase, dormant phase, restructure phase - Primary phase, secondary phase, third phase

- Reactive phase, reparative phase, remodeling phase

After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement? - Revascularization - Inflammation - Remodeling - Reparative

- Remodeling

A client is seen in the emergency room for a knee injury that happened during a basketball game. Diagnostic tests reveal torn cords of fibrous connective tissue that connect muscles to bones. What type of tear has this client sustained? - Ligament - Bursa - Tendon - Fascia

- Tendon

A client is recovering from a fractured hip. What would the nurse suggest that the client increase intake of to facilitate calcium absorption from food and supplements? - Amino acids - Dairy products - Vitamin B6 - Vitamin D

- Vitamin D

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse? -"CPM increases range of motion of the joint." -"CPM strengthens the muscles of the leg." -"CPM delivers analgesic agents directly into the joint." -"CPM prevents injury by limiting flexion of the knee."

-"CPM increases range of motion of the joint." CPM increases circulation and range of motion of the knee joint.

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? -"Metal pins will go through my skin to the bone." -"I will wear a boot with weights attached." -"A belt will go around my pelvis and weights will be attached." -"The traction can be removed once a day so I can shower."

-"Metal pins will go through my skin to the bone." In skeletal traction, metal rods or pins are used to apply continuous traction directly to the bone. Weights are used to apply the traction. Casts, external fixators, or splints are used when the traction is discontinued.

A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first? -"My toes are stiff." -"My toes are pink." -"My cast is still wet." -"My pain is a 3."

-"My toes are stiff." Compartment syndrome is characterized by neurovascular compromise. Stiffness of the toes may be a preliminary finding that the client is having trouble with motor function.

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? -Assessing the extremity for neurovascular integrity -Keeping the client from sliding to the foot of the bed -Keeping the ropes over the center of the pulley -Ensuring that the weights hang free at all times

-Assessing the extremity for neurovascular integrity Although all measures are correct, assessing neurovascular integrity takes priority because a decrease in neurovascular integrity could compromise the limb. The pull of the traction must be continuous to keep the client from sliding. Sufficient countertraction must be maintained at all times by keeping the ropes over the center of the pulley. The line of pull is maintained by allowing the weights to hang free.

A patient had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated? -The left leg is internally rotated. -The leg length is the same as the right leg. -The patient has discomfort when moving in the bed. -Diminished peripheral pulses on the affected extremity

-The left leg is internally rotated. The nurse must monitor for signs and symptoms of dislocation of the prosthesis, which include abnormal external or internal rotation of the affected extremity.

Which statement describes external fixation? -The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. -The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. -The bone is restored to its normal position by external manipulation. -The bone is surgically exposed and realigned.

-The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. In internal fixation, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. In closed reduction, the bone is restored to its normal position by external manipulation. In open reduction, the bone is surgically exposed and realigned.

Which intervention would the nurse implement with the client in skeletal traction? Select all that apply. -Apply 8-pound weight to the rope. -Ensure the pins or wires are covered with caps. -Remove foam boot and inspect skin daily. -Position trapeze within the client's reach. -Instruct the client on isometric exercises for immobilized extremity.

-Ensure the pins or wires are covered with caps. -Position trapeze within the client's reach. -Instruct the client on isometric exercises for immobilized extremity. Nursing care of the client in skeletal traction includes ensuring the trapeze is within the client's reach and the pins or wires are covered with caps. The nurse instructs the client on isometric exercises for the immobilized extremity. A foam boot is used with Buck's traction (skin traction) not skeletal traction. An 8-pound weight is used with Buck's traction, whereas a 15- to 25-pound weight is applied in skeletal traction.

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? -Arthrodesis -Hemiarthroplasty -Total arthroplasty -Osteotomy

-Total arthroplasty A total arthroplasty is a replacement of both articular surfaces within one joint. An arthrodesis is a fusion of a joint for stabilization and pain relief and is usually done on a wrist or knee. A hemiarthroplastyis the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. An osteotomy is the cutting and removal of a wedge of bone to change the bone's alignment, thereby improving function and relieving pain.

A nurse is providing care for a patient whose pattern of laboratory testing reveals longstanding hypocalcemia. What other laboratory result is most consistent with this finding? A) An elevated parathyroid hormone level B) An increased calcitonin level C) An elevated potassium level D) A decreased vitamin D level

A

An older adult patient has symptoms of osteoporosis and is being assessed during her annual physical examination. The assessment shows that the patient will require further testing related to a possible exacerbation of her osteoporosis. The nurse should anticipate what diagnostic test? A) Bone densitometry B) Hip bone radiography C) Computed tomography (CT) D) Magnetic resonance imaging (MRI)

A) Bone densitometry

A nurse is planning the care of an older adult patient who will soon be discharged home after treatment for a fractured hip. In an effort to prevent future fractures, the nurse should encourage which of the following? Select all that apply. A) Regular bone density testing B) A high-calcium diet C) Use of falls prevention precautions D) Use of corticosteroids as ordered E) Weight-bearing exercise

A, B, C, E