Chp. 62: Musculoskeletal Trauma and Orthopedic Surgery
A patient who had a below-the-knee amputation is to be fitted with a temporary prosthesis. What is most important to teach the patient? A) Inspect the residual limb daily for irritation B) Apply an elastic shrinker before applying the prosthesis C) Perform range-of-motion (ROM) exercises to the affected leg 4 times a day D) Apply alcohol to the residual limb every morning and evening to toughen the skin
A) Inspect the residual limb daily for irritation
After being hospitalized for 3 days with a right femur fracture, a 32-year-old patient suddenly develops shortness of breath and tachypnea. The patient tells the nurse, I feel like I am going to die! Which action should the nurse take first? A) Stay with the patient and offer reassurance B) Administer the prescribed PRN oxygen at 4 L/min C) Check the patients legs for swelling or tenderness D) Notify the health care provider about the symptoms
B) Administer the prescribed PRN oxygen at 4 L/min
When caring for a patient who is using Bucks traction after a hip fracture, which action can the nurse delegate to unlicensed assistive personnel (UAP)? A) Monitor the skin under the traction boot for redness B) Ensure that the weight for the traction is off the floor C) Check for intact sensation and movement in the affected leg D) Offer reassurance that hip and leg pain are normal after hip fracture
B) Ensure that the weight for the traction is off the floor
Which information obtained by the nurse about a 29-year-old patient with a lumbar vertebral compression fracture is most important to report to the health care provider? A) Patient refuses to be turned due to back pain B) Patient has been incontinent of urine and stool C) Patient reports lumbar area tenderness to palpation D) Patient frequently uses oral corticosteroids to treat asthma
B) Patient has been incontinent of urine and stool
A patient who slipped and fell in the shower at home has a proximal humerus fracture immobilized with a left-sided long-arm cast and a sling. Which nursing intervention will be included in the plan of care? A) Use surgical net dressing to hang the arm from an IV pole B) Immobilize the fingers of the left hand with gauze dressings C) Assess the left axilla and change absorbent dressings as needed D) Assist the patient in passive range of motion (ROM) for the right arm
C) Assess the left axilla and change absorbent dressings as needed
When teaching seniors at a community recreation center, which information will the nurse include about ways to prevent fractures? A) Tack down scatter rugs in the home B) Most falls happen outside the home C) Buy shoes that provide good support and are comfortable to wear D) Range-of-motion exercises should be taught by a physical therapist
C) Buy shoes that provide good support and are comfortable to wear
The second day after admission with a fractured pelvis, a 64-year-old patient suddenly develops confusion. Which action should the nurse take first? A) Take the blood pressure B) Assess patient orientation C) Check the oxygen saturation D) Observe for facial asymmetry
C) Check the oxygen saturation
Which type of fracture can cause radial nerve and brachial artery damage and is reduced with a hanging arm cast? A) Fractured tibia B) Colles' fracture C) Fractured humerus D) Femoral shaft fracture
C) Fractured humerus
The athlete comes to the clinic with bursitis. What does the nurse know happens to the tissue to cause pain when bursitis occurs? A) Tearing of a ligament B) Stretching of muscle and fascia sheath C) Inflammation of synovial membrane sac at friction sites D) Incomplete separation of articular surfaces of joint caused by ligament injury
C) Inflammation of synovial membrane sac at friction sites
A 42-year-old patient is admitted to the emergency department with a left femur fracture. Which information obtained by the nurse is most important to report to the health care provider? A) Ecchymosis of the left thigh B) Complaints of severe thigh pain C) Slow capillary refill of the left foot D) Outward pointing toes on the left foot
C) Slow capillary refill of the left foot
At what point following a fracture does the nurse need to most carefully evaluate the patient for the development of a fat embolism? A) The first 2-3 hours B) The first 8 hours C) The first 24-48 hours D) For the first week following the injury
C) The first 24-48 hours
A patient arrived at the emergency department after tripping over a rug and falling at home. Which finding is most important for the nurse to communicate to the health care provider? A) There is bruising at the shoulder area B) The patient reports arm and shoulder pain C) The right arm appears shorter than the left D) There is decreased shoulder range of motion
C) The right arm appears shorter than the left
When a patient arrives in the emergency department with a facial fracture, which action will the nurse take first? A) Assess for nasal bleeding and pain B) Apply ice to the face to reduce swelling C) Use a cervical collar to stabilize the spine D) Check the patients alertness and orientation
C) Use a cervical collar to stabilize the spine
Which discharge instruction will 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) Use pillows to elevate the ankle above the heart
The nurse is completing a neurovascular assessment on the patient with a tibial fracture and a cast. The feet are pulseless, pale, and cool. The patient says they are numb. What should the nurse suspect is occurring? A) Paresthesia B) Pitting edema C) Poor venous return D) Compartment syndrome
D) Compartment syndrome
Patient-Centered Care: A 72-year-old man tells the nurse that he cannot perform most of the physical activities he could do 5 years ago because of overall joint aches and pains. What can the nurse do to help the patient prevent further deconditioning and decrease the risk for developing musculoskeletal problems? A) Limit weight-bearing exercise to prevent stress on fragile bones and possible hip fractures B) Tell the patient to avoid using canes and walkers because they increase dependence on ambulation aids C) Teach the patient to increase his activity by climbing stairs in buildings and other environments with steps D) Discuss the use of stretching and strengthening exercises to decrease aches and pain so that exercise can be maintained
D) Discuss the use of stretching and strengthening exercises to decrease aches and pain so that exercise can be maintained
What should the nurse include in discharge instructions for the patient after a hip prosthesis with a posterior approach? A) Restrict walking for 2 to 3 months B) Take a bath rather than a shower to prevent falling C) Keep the leg internally rotated while sitting and standing D) Have a family member help the patient put on shoes and socks
D) Have a family member help the patient put on shoes and socks
A factory line worker has repetitive strain syndrome in the left elbow. The nurse will plan to teach the patient about? A) Surgical options B) Elbow injections C) Wearing a left wrist splint D) Modifying arm movements
D) Modifying arm movements
An older adult woman is admitted to the ED after falling at home. The nurse cautions her not to put weight on the leg after finding what in the patient assessment? A) Inability to move the toes and ankle B) Edema of the thigh extending to the knee C) Internal rotation of the leg with groin pain D) Shortening and external rotation of the leg
D) Shortening and external rotation of the leg
Which action will the nurse include in the plan of care for a patient who has had a total right knee arthroplasty? A) Avoid extension of the right knee beyond 120 degrees B) Use a compression bandage to keep the right knee flexed C) Teach about the need to avoid weight bearing for 4 weeks D) Start progressive knee exercises to obtain 90-degree flexion
D) Start progressive knee exercises to obtain 90-degree flexion
A patient with a fractured right hip has an anterior ORIF of the fracture. What should the nurse plan to do postoperatively? A) Get the patient up to the chair on the first postoperative day B) Ambulate the patient with partial weight bearing by discharge C) Keep the leg abductor pillow on the patient even when bathing D) Position the patient only on the back and the nonoperative side
A) Get the patient up to the chair on the first postoperative day
Priority Decision: An immediate postoperative prosthetic fitting during surgery is used for a patient with a traumatic below-the-knee amputation. During the immediate postoperative period, what is a priority nursing intervention? A) Monitor the patient's vital signs B) Assess the incision for hemorrhage C) Elevate the residual limb on pillows D) Have the patient flex and extend the knee every hour
A) Monitor the patient's vital signs
A 32-year-old patient who has had an open reduction and internal fixation (ORIF) of left lower leg fractures continues to complain of severe pain in the leg 15 minutes after receiving the prescribed IV morphine. Pulses are faintly palpable and the foot is cool. 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 patients blood pressure
A) Notify the health care provider
The occupational health nurse will teach the patient whose job involves many hours of typing about the need to? 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 anti-inflammatory drugs (NSAIDs) for pain
A) Obtain a keyboard pad to support the wrist
The patient had a fracture. At 3 weeks to 6 months there is clinical union, and this is the first stage of healing that is sufficient to prevent movement of the fracture site when the bones are gently stressed. How is this stage of fracture healing documented? A) Ossification B) Remodeling C) Consolidation D) Callus formation
A) Ossification
Which nursing action for a patient who has had right hip replacement surgery can the nurse delegate to experienced unlicensed assistive personnel (UAP)? A) Reposition the patient every 1 to 2 hours B) Assess for skin irritation on the patient's back C) Teach the patient quadriceps-setting exercises D) Determine the patient's pain level and tolerance
A) Reposition the patient every 1 to 2 hours
A patient with a fractured femur develops the complication of malunion. What does the nurse recognize has happened to the patient? A) The fracture heals in an unsatisfactory position B) The fracture fails to heal properly despite treatment C) Fracture healing progresses more slowly than expected D) Loss of bone substances occurs as a result of immobilization
A) The fracture heals in an unsatisfactory position
What is the reason a nurse should position a patient prone several times a day after an above-the-knee amputation with a delayed prosthetic fitting? A) To prevent flexion contractures B) To assess the posterior skin flap C) To reduce edema in the residual limb D) To relieve pressure on the incision site
A) To prevent flexion contractures
A patient with a right lower leg fracture will be discharged home with an external fixation device in place. Which information will the nurse teach? A) You will need to check and clean the pin insertion sites daily B) The external fixator can be removed for your bath or shower C) You will need to remain on bed rest until bone healing is complete D) Prophylactic antibiotics are used until the external fixator is removed
A) You will need to check and clean the pin insertion sites daily
The x-ray shows that the patient's fracture is at the remodeling stage. What characteristics of the fracture healing process occur at this stage (select all that apply)? A) Radiologic union B) Absorption of excess bone cells C) Return to pre-injury strength and shape D) Semisolid blood clot at the ends of fragments E) Deposition and absorption of bone in response to stress F) Unorganized network of bone woven around fracture parts
A, B, C, E
What should be included in the management during the first 48 hours after an acute soft tissue injury of the ankle (select all that apply)? A) Use of elastic wrap B) Initial immobilization and rest C) Elevation of ankle above the heart D) Alternating the use of heat and cold E) Administration of anti-inflammatory drugs
A, B, C, E
What emergency considerations must be included with facial fractures (select all that apply)? A) Airway patency B) Oral examination C) Cervical spine injury D) Cranial nerve assessment E) Immobilization of the jaw
A, C
Which statement by a 62-year-old patient who has had an above-the-knee amputation indicates that 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 lay 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) "I should lay flat on my abdomen for 30 minutes 3 or 4 times a day."
The patient asks, "What does the doctor mean when he says that I have an avulsion fracture in my leg? I thought I had a sprain!" What is the best response by the nurse? A) "It is a fracture with more than 2 fragments." B) "It means that a ligament pulled a bone fragment loose." C) "The line of the fracture is twisted along the shaft of the bone." D) "The line of the fracture is at right angles to the longitudinal axis of the bone."
B) "It means that a ligament pulled a bone fragment loose."
A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which nursing assessment finding is important to report to the health care provider? A) The patient states that the pelvis feels unstable. B) Abdomen is distended and bowel sounds are absent C) There are ecchymoses across the abdomen and hips D) The patient complains of pelvic pain with palpation
B) Abdomen is distended and bowel sounds are absent
When positioning the patient after a total hip arthroplasty with a posterior approach, it is important that the nurse maintain the affected extremity in what position? A) Adduction and flexion B) Abduction and extension C) Abduction and internal rotation D) Adduction and external rotation
B) Abduction and extension
The day after a having a right below-the-knee amputation, a patient complains of pain in the right foot. Which action is best for the nurse to take? A) Explain the reasons for the phantom limb pain B) Administer prescribed analgesics to relieve the pain C) Loosen the compression bandage to decrease incisional pressure D) Inform the patient that this phantom pain will diminish over time
B) Administer prescribed analgesics to relieve the pain
Before assisting a patient with ambulation 2 days after a total hip replacement, which action is most important for the nurse to take? A) Observe the status of the incisional drain device B) Administer the ordered oral opioid pain medication C) Instruct the patient about the benefits of ambulation D) Change the hip dressing and document the wound appearance
B) Administer the ordered oral opioid pain medication
Which action will the nurse take in order to evaluate the effectiveness of Bucks traction for a 62-year-old patient who has an intracapsular fracture of the right femur? A) Check peripheral pulses B) Ask about hip pain level C) Assess for hip contractures D) Monitor for hip dislocation
B) Ask about hip pain level
Which nursing intervention will be included in the plan of care after a patient with a right femur fracture has a hip spica cast applied? A) Avoid placing the patient in prone position B) Ask the patient about abdominal discomfort C) Discuss remaining on bed rest for several weeks D) Use the cast support bar to reposition the patient
B) Ask the patient about abdominal discomfort
A patient has a long-arm plaster cast applied for immobilization of a fractured left radius. Until the cast has completely dried, the nurse should? A) Keep the left arm in dependent position B) Avoid handling the cast using fingertips C) Place gauze around the cast edge to pad any roughness D) Cover the cast with a small blanket to absorb the dampness
B) Avoid handling the cast using fingertips
A patient who has had an open reduction and internal fixation (ORIF) of a hip fracture tells the nurse that he is ready to get out of bed for the first time. Which action should the nurse take? A) Use a mechanical lift to transfer the patient from the bed to the chair B) Check the postoperative orders for the patients weight-bearing status C) Avoid administration of pain medications before getting the patient up D) Delegate the transfer of the patient to nursing assistive personnel (NAP)
B) Check the postoperative orders for the patients weight-bearing status
A patient undergoes a left above-the-knee amputation with an immediate prosthetic fitting. When the patient arrives on the orthopedic unit after surgery, the nurse should? A) Place the patient in a prone position B) Check the surgical site for hemorrhage C) Remove the prosthesis and wrap the site D) Keep the residual leg elevated on a pillow
B) Check the surgical site for hemorrhage
The nurse will instruct the patient with a fractured left radius that the cast will need to remain in place? A) For several months B) For at least 3 weeks C) Until swelling of the wrist has resolved D) Until x-rays show complete bony union
B) For at least 3 weeks
When doing discharge teaching for a 19-year-old patient who has had a repair of a fractured mandible, the nurse will include information about? 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) How and when to cut the immobilizing wires
The patient is brought to the emergency department after a car accident and has a femur fracture. What nursing intervention should the nurse implement to prevent a fat embolus in this patient? A) Administer enoxaparin (Lovenox) B) Immobilize the fracture preoperatively C) Provide range-of-motion exercises D) Apply sequential compression boots
B) Immobilize the fracture preoperatively
Priority Decision: A patient with severe ulnar deviation of the hands undergoes an arthroplasty with reconstruction and replacement of finger joints. Postoperatively, what is it most important for the nurse to do? A) Position the fingers lower than the elbow at all times B) Perform neurovascular assessments of the fingers every 2 to 4 hours C) Encourage the patient to gently flex, extend, abduct, and adduct the fingers every 4 hours D) Remind the patient that function of the hands is more important than cosmetic appearance
B) Perform neurovascular assessments of the fingers every 2 to 4 hours
Application of RICE (rest, ice, compression, elevation) is indicated for initial management of which type of injury? A) Muscle spasms B) Sprains and strains C) Repetitive strain injury D) Dislocations and subluxations
B) Sprains and strains
A patient who is to have no weight bearing on the left leg is learning to walk using crutches. Which observation by the nurse indicates that 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) The patient advances the left leg and both crutches together and then advances the right leg
A patient is being discharged 4 days after hip replacement surgery using the posterior approach. Which patient action requires immediate intervention by the nurse? A) The patient uses crutches with a swing-to gait B) The patient leans over to pull shoes and socks on C) The patient sits straight up on the edge of the bed D) The patient bends over the sink while brushing teeth
B) The patient leans over to pull shoes and socks on
Priority Decision: A patient is admitted with an open fracture of the tibia after a bicycle accident. What question should the nurse ask when assessing the patient? A) Any previous injuries to the leg B) The status of tetanus immunization C) The use of antibiotics in the last month D) Whether the injury was exposed to dirt or gravel
B) The status of tetanus immunization
When assessing for Tinel's sign in a patient with possible right-sided carpal tunnel syndrome, the nurse will ask the patient about? A) Weakness in the right little finger B) Tingling in the right thumb and fingers C) Burning in the right elbow and forearm D) Tremor when gripping with the right hand
B) Tingling in the right thumb and fingers
After a total knee arthroplasty, a patient has a continuous passive motion (CPM) machine for the affected joint. What should the nurse explain to the patient is the purpose of this device? A) To relieve edema and pain at the incision site B) To promote early joint mobility and increase knee flexion C) To prevent venous stasis and the formation of a deep venous thrombosis D) To improve arterial circulation to the affected extremity to promote healing
B) To promote early joint mobility and increase knee flexion
A young man arrives in the emergency department with ankle swelling and severe pain after twisting his ankle playing basketball. Which of these prescribed collaborative interventions will the nurse implement first? A) Take the patient to have x-rays B) Wrap the ankle and apply an ice pack C) Administer naproxen (Naprosyn) 500 mg PO D) Give acetaminophen with codeine (Tylenol #3)
B) Wrap the ankle and apply an ice pack
A 22-year-old tennis player has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included? A) You will not be able to serve a tennis ball again B) You will work with a physical therapist tomorrow C) The doctor will use the drop-arm test to determine the success of surgery D) Leave the shoulder immobilizer on for the first 4 days to minimize pain
B) You will work with a physical therapist tomorrow
Which statement by the patient indicates a good understanding of the nurses teaching about a new short-arm plaster cast? A) "I can get the cast wet as long as I dry it right away with a hair dryer." B) "I should avoid moving my fingers and elbow 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) "I will apply an ice pack to the cast over the fracture site off and on for 24 hours."
A high school teacher with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for a left hand arthroplasty. Which patient statement to the nurse indicates a realistic expectation for the surgery? A) "This procedure will correct the deformities in my fingers." B) "I will not have to do as many hand exercises after the surgery." C) "I will be able to use my fingers with more flexibility to grasp things." D) "My fingers will appear more normal in size and shape after this surgery."
C) "I will be able to use my fingers with more flexibility to grasp things."
After the health care provider has recommended 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) "Tell me what you know about your options for treatment."
When giving home care instructions to a patient who has comminuted forearm fractures and a long-arm cast on the left arm, which information should the nurse include? A) Keep the left shoulder elevated on a pillow or cushion B) Keep the hand immobile to prevent soft tissue swelling C) Call the health care provider for increased swelling or numbness of the hand D) Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) for 24 hours after the injury
C) Call the health care provider for increased swelling or numbness of the hand
Following a motorcycle accident, a 58-year-old patient arrives in the emergency department with massive left lower leg swelling. Which action will the nurse take first? A) Elevate the leg on 2 pillows B) Apply a compression bandage C) Check leg pulses and sensation D) Place ice packs on the lower leg
C) Check leg pulses and sensation
A pedestrian who was hit by a car is admitted to the emergency department with possible right lower leg fractures. The initial action by the nurse should be to? A) Elevate the right leg B) Splint the lower leg C) Check the pedal pulses D) Verify tetanus immunizations
C) Check the pedal pulses
A woman with osteoporosis slipped on the ice and now her wrist hurts. If there is a fracture, what type of fracture is expected? A) Dislocation B) Open fracture C) Colles' fracture D) Incomplete fracture
C) Colles' fracture
Patient-Centered Care: A patient with a fractured tibia accompanied by extensive soft tissue damage initially has a splint applied and held in place with an elastic bandage. What early sign would alert the nurse that the patient is developing compartment syndrome? A) Paralysis of the toes B) Absence of peripheral pulses C) Distal pain unrelieved by opioid analgesics D) Skin over the injury site is blanched when the bandage is removed
C) Distal pain unrelieved by opioid analgesics
When completing discharge teaching with an 80 y/o patient who underwent right total hip arthroplasty, a need for further instruction is identified when the patient states which of the following? A) Avoid crossing his legs B) Use a toilet elevator on toilet seat C) Maintain hip in adduction and internal rotation D) Notify future caregivers about the prosthesis
C) Maintain hip in adduction and internal rotation
A patient who arrives at the emergency department experiencing severe left knee pain is diagnosed with a patellar dislocation. The initial patient teaching by the nurse will focus on the need for? A) A knee immobilizer B) Gentle knee flexion C) Monitored anesthesia care D) Physical activity restrictions
C) Monitored anesthesia care
What assessment findings distinguish a fat embolism from a pulmonary embolism in a patient with a fracture? A) Tachycardia and dyspnea B) A sudden onset of chest pain C) Petechiae around the neck and upper chest D) Electrocardiographic (ECG) changes and decreased partial pressure of oxygen in arterial blood (PaO2)
C) Petechiae around the neck and upper chest
Priority Decision: Twenty-four hours after a below-the-knee amputation, a patient uses the call system to tell the nurse that his dressing (a compression bandage) has fallen off. What should be the nurse's first action? A) Apply ice to the site B) Cover the incision with dry gauze C) Reapply the compression dressing D) Elevate the extremity on 2 pillows
C) Reapply the compression dressing
When the nursing student asks the registered nurse (RN) what an arthroplasty is, what is the best description the RN can give the student? A) Surgical fusion of a joint to relieve pain B) Correction of bone deformity by removal of a wedge or slice of bone C) Reconstruction or replacement of a joint to relieve pain and correct deformity D) Used in rheumatoid arthritis to remove the tissue involved in joint destruction
C) Reconstruction or replacement of a joint to relieve pain and correct deformity
A patient with an extracapsular hip fracture is admitted to the orthopedic unit and placed in Buck's traction. How should the nurse explain the purpose of the traction to the patient? A) Pulls bone fragments back into alignment B) Immobilizes the leg until healing is complete C) Reduces pain and muscle spasms before surgery D) Prevents damage to the blood vessels at the fracture site
C) Reduces pain and muscle spasms before surgery
In which order will the nurse take these actions when caring for a patient in the ED with a right leg fracture after a motor vehicle accident? A) Obtain x-rays B) Check pedal pulses C) Assess lung sounds D) Take BP E) Apply splint to the leg F) Administer tetanus prophylaxis
C, D, B, E, A, F
A patient had a right total hip arthroplasty with a cemented prosthesis for treatment of severe osteoarthritis of the hip. What activity should the nurse include on the patient's first postoperative day? A) Transfer from the bed to the chair twice a day only B) Only turning from the back to both sides every 2 hours C) Crutch walking with non-weight bearing on the operative leg D) Ambulation with a walker and limited weight bearing on the right leg
D) Ambulation with a walker and limited weight bearing on the right leg
A young patient with a fractured femur has a hip spica cast applied. What is the most important action the nurse should take while the cast is drying? A) Elevate the legs above the level of the heart for 24 hours B) Turn the patient to both sides and prone to supine every 2 hours C) Cover the cast with a light blanket to avoid chilling from evaporation D) Assess the patient frequently for abdominal pain, nausea, and vomiting
D) Assess the patient frequently for abdominal pain, nausea, and vomiting
Which finding in a patient with a Colle's fracture of the left wrist is most important to communicate to the health care provider? A) Swelling is noted around the wrist B) The patient is reporting severe pain C) The wrist has a deformed appearance D) Capillary refill to the fingers is prolonged
D) Capillary refill to the fingers is prolonged
The patient works on a computer 8 hours each day. What kind of injury would the nurse assess for in this patient? A) Meniscus injury B) Rotator cuff injury C) Radial-ulnar fracture D) Carpal tunnel syndrome
D) Carpal tunnel syndrome
A 48-year-old patient with a comminuted fracture of the left femur has Bucks traction in place while waiting for surgery. To assess for pressure areas on the patients back and sacral area and to provide skin care, the nurse should? A) Loosen the traction and help the patient turn onto the unaffected side B) Place a pillow between the patients legs and turn gently to each side C) Turn the patient partially to each side with the assistance of another nurse D) Have the patient lift the buttocks by bending and pushing with the right leg
D) Have the patient lift the buttocks by bending and pushing with the right leg
After change-of-shift report, which patient should the nurse assess first? A) Patient with a Colle's fracture who has right wrist swelling and deformity B) Patient with a intracapsular left hip fracture whose leg is externally rotated C) Patient with a repaired mandibular fracture who is complaining of facial pain D) Patient with right femoral shaft fracture whose thigh is swollen and ecchymotic
D) Patient with right femoral shaft fracture whose thigh is swollen and ecchymotic
Priority Decision: A patient who fell in the bathroom of the hospital room reports pain in the upper right arm and elbow. Which action should the nurse take first in managing a possible fracture before splinting the injury? A) Elevate the arm B) Apply ice to the site C) Notify the health care provider D) Perform a neurovascular check below the injury
D) Perform a neurovascular check below the injury
. The day after a 60-year-old patient has an open reduction and internal fixation (ORIF) for an open, displaced tibial fracture, the priority nursing diagnosis is? A) Activity intolerance related to deconditioning B) Risk for constipation related to prolonged bed rest C) Risk for impaired skin integrity related to immobility D) Risk for infection related to disruption of skin integrity
D) Risk for infection related to disruption of skin integrity
After a fracture the nurses assesses the client for what common symptom and reliable early clinical indicator of compartment syndrome? A) Pain that is controlled by opioids B) Decreased capillary refill of the affected limb C) Petechiae of the axilla D) Severe, unrelenting pain in the affected limb
D) Severe, unrelenting pain in the affected limb
Patient-Centered Care: A patient is discharged from the outpatient clinic after application of a synthetic fiberglass long arm cast for a fractured ulna. Before discharge, what instruction should the nurse provide to the patient? A) Never get the cast wet B) Move the shoulder and fingers frequently C) Place tape petals around the edges of the cast when it is dry D) Use a sling to support the arm at waist level for the first 48 hours
B) Move the shoulder and fingers frequently
If surgery is needed, which procedure would the nurse first prepare the patient for in the presence of compartment syndrome? A) Fasciotomy B) Amputation C) Internal fixation D) Release of tendons
A) Fasciotomy
What is a disadvantage of open reduction and internal fixation (ORIF) of a fracture compared to closed reduction? A) Infection B) Skin irritation C) Nerve impairment D) Complications of immobility
A) Infection
Which kind of hip fracture is usually repaired with a hip prosthesis? A) Intracapsular B) Extracapsular C) Subtrochanteric D) Intertrochanteric
A) Intracapsular
Which joint surgery is used to arthroscopically remove devitalized tissue in joints? A) Osteotomy B) Arthrodesis C) Debridement D) Synovectomy
C) Debridement
When is a fat embolism most likely to occur? A) 24 to 48 hours after a fractured tibia B) 36 to 72 hours after a skull fracture C) 4 to 5 days after a fractured femur D) 5 to 6 days after a pelvic fracture
A) 24 to 48 hours after a fractured tibia
A client surgical repair of a fractured left hip. When repositioning the client onto his side in the bed, the nurse plans to use which of the following as the most important item for this maneuver? A) Abductor splint B) Adductor splint C) A bed pillow D) Overhead trapeze
A) Abductor splint
A patient reports pain in the foot of a leg that was recently amputated. What should the nurse recognize about this pain? A) It is caused by swelling at the incision B) It should be treated with ordered analgesics C) It will become worse with the use of a prosthesis D) It can be managed with diversion because it is psychologic
B) It should be treated with ordered analgesics
In a patient with a stable vertebral fracture, what should the nurse teach the patient? A) Remain on bed rest until the pain is gone B) Logroll to keep the spine straight when turning C) How to use bone cement to correct the problem D) Take as much analgesic as needed to relieve the pain
B) Logroll to keep the spine straight when turning
A patient is brought to the emergency department (ED) with an injured lower left leg following a fall while rock climbing. The nurse identifies the presence of a fracture based on what cardinal sign of fracture? A) Muscle spasms B) Obvious deformity C) Edema and swelling D) Pain and tenderness
B) Obvious deformity
When preparing a patient for discharge after intermaxillary fixation of a mandibular fracture, which statement indicates that patient teaching has been successful? A) "I can keep my mouth moist by sucking on hard candy." B) "I should cut the wires with scissors if I begin to vomit." C) "I may use a bulk-forming laxative if my liquid diet causes constipation." D) "I should use a moist swab to clean my mouth every time I eat something."
C) "I may use a bulk-forming laxative if my liquid diet causes constipation."
Which action will the urgent care nurse take when caring for a patient who has a possible knee meniscus injury? A) Encourage bed rest for 24 to 48 hours B) Avoid palpation or movement of the knee C) Apply a knee immobilizer to the affected leg D) Administer intravenous narcotics for pain relief
C) Apply a knee immobilizer to the affected leg
How should the nurse assess the neurologic status of the patient with a fractured humerus? A) Have the patient evert, invert, dorsiflex, and plantar flex the foot B) Assess the location, quality, and intensity of pain below the site of the injury C) Have the patient abduct the fingers, oppose the thumb and fingers, and flex and extend the wrist D) Assess the color, temperature, capillary refill, peripheral pulses, and edema in the extremity
C) Have the patient abduct the fingers, oppose the thumb and fingers, and flex and extend the wrist
The patient with osteoporosis had a spontaneous hip fracture. How should the nurse document this before the x-ray results return? A) Open fracture B) Oblique fracture C) Pathologic fracture D) Greenstick fracture
C) Pathologic fracture
The nurse is caring for a patient who is to be discharged from the hospital 5 days after insertion of a femoral head prosthesis using a posterior approach. Which statement by the patient indicates a need for additional instruction? A) "I should not cross my legs while sitting." B) "I will use a toilet elevator on the toilet seat." C) "I will have someone else put on my shoes and socks." D) "I can sleep in any position that is comfortable for me."
D) "I can sleep in any position that is comfortable for me."
Priority Decision: After change-of-shift handoff, which patient should the nurse assess first? A) A 58-year-old male reporting phantom pain and requesting an analgesic B) A 72-year-old male being transferred to a skilled nursing unit after repair of a hip fracture C) A 25-year-old female in left leg skeletal traction asking for the weights to be lifted for a few minutes D) A 68-year-old male with a new lower leg cast reporting the cast is too tight and he cannot feel his toes
D) A 68-year-old male with a new lower leg cast reporting the cast is too tight and he cannot feel his toes
