CH 37 PrepU
A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse?
"Elevating the leg might lead to a flexion contracture."
A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?
"I don't know if I'll be able to get off that low toilet seat at home by myself."
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."
A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and observes petechiae on the client's chest. Which nursing action is indicated first?
Administer oxygen.
A client with a fractured femur is placed in skeletal traction. Which intervention will increase client independence when moving in bed?
Apply a trapeze to the bed frame.
When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction?
Apply ice to the fracture site.
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?
Apply lotions and take warm baths or soaks.
Which action would be most important postoperatively for a client who has had a knee or hip replacement?
Assisting in early ambulation.
A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect?
Avascular necrosis
An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement?
Avascular necrosis may develop at the site if it is not promptly resolved.
The orthopedic surgeon has prescribed balanced skeletal traction for a client. What advantage is conferred by balanced traction?
Balanced traction allows for greater client movement and independence than other forms of traction.
Which type of fracture is one in which the skin or mucous membrane wound extends to the fractured bone?
Compound
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?
Crackles in the lung bases
The health care provider is preparing to bivalve the client's cast. Which supplies should the nurse assemble?
Elastic compression bandages
Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture?
Encourage participation in ADLs
A client with a fracture develops compartment syndrome that requires surgical intervention. What treatment will the nurse would most likely prepare the client for?
Fasciotomy
A nurse is caring for a client after stabilization of a radial fracture. Which actions by the nurse would be appropriate for the client following arm casting? Select all that apply.
Handle the cast with the palms of hands, Circulate room air with a portable fan, Petal and smooth the edges of the cast
The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, "How can I stay like this for weeks? I can't even move!" Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis?
Ineffective Coping related to prolonged immobility
A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?
Keeping a pillow between the client's legs at all times
After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority?
Maintaining traction continuously to ensure its effectiveness
Which term refers to the failure of fragments of a fractured bone to heal together?
Nonunion
A nurse is admitting a client to the unit who presented with a lower extremity fracture. What signs and symptoms would suggest to the nurse that the client may have a peroneal nerve injury?
Numbness and burning of the foot
A nurse is caring for a client who is recovering in the hospital following orthopedic surgery. The nurse is performing frequent assessments for signs and symptoms of infection in the knowledge that the client faces a high risk of what infectious complication?
Osteomyelitis
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?
Pathologic fracture
Elderly clients who fall are most at risk for which injuries?
Pelvic fractures
The RICE acronym is helpful for remembering treatment interventions for musculoskeletal injuries. Which of the following are components of the RICE acronym? Select all that apply.
Rest, Ice, Compression, Elevation
Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain?
Rotator cuff tears
A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain?
Sharp and piercing
The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed?
The skin may be covered with a yellowish crust that will shed in a few days.
A client is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm?
Use of isometric exercises
Which may occur if a client experiences compartment syndrome in an upper extremity?
Volkmann's contracture
The type of fracture described as having one side of the bone broken and the other side bent would be:
greenstick.
A client has been in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma?
immobilization
A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would the physician perform?
joint manipulation and immobilization
A fracture is considered pathologic when it
occurs through an area of diseased bone.
A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period?
osteomyelitis
A group of students is 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?
Better molding to the client
The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Fahrenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which complication?
Hypovolemic shock
The nurse is caring for a 24-year-old female client with a right tibial fracture treated with a cast 2 hours ago. The client now reports unrelenting pain, rated as 7/10, despite taking oxycodone, and decreased sensation in the right foot. A nursing assessment reveals the right foot is cooler and paler than the left foot, with delayed capillary refill and a weak pulse. Based on the nursing assessment, the priority action the nurse should take is to
notify the orthopedic health care provider immediately and prepare the client for bivalving of the cast
