Exam 2 - MedSurgIV
A client is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The client has been placed in traction until the femur can be rodded in surgery. For what early complication(s) should the nurse monitor this client? Select all that apply. - Systemic infection - Complex regional pain syndrome - Deep vein thrombosis - Compartment syndrome - Fat embolism
- Deep vein thrombosis - Compartment syndrome - Fat embolism Rationale: Early complications include shock, fat embolism, compartment syndrome, and venous thromboemboli (deep vein thrombosis [DVT], pulmonary embolism [PE]). Infection and complex regional pain syndrome are later complications of fractures.
A nurse is caring for a client whose cancer metastasis has resulted in bone pain. What should the nurse expect the client to describe? - A dull, deep ache that is "boring" in nature - Soreness or aching that may include cramping - Sharp, piercing pain that is relieved by immobilization - Spastic or sharp pain that radiates
A dull, deep ache that is "boring" in nature Rationale: Bone pain is characteristically described as a dull, deep ache that is "boring" in nature, whereas muscular pain is described as soreness or aching and is referred to as "muscle cramps." Fracture pain is sharp and piercing and is relieved by immobilization. Sharp pain may also result from bone infection with muscle spasm or pressure on a sensory nerve. pg. 1104 ch. 35
A nurse is assessing a client who is experiencing peripheral neurovascular dysfunction. Which assessment findings are most consistent with this diagnosis? - Hot skin and a capillary refill of 1 to 2 seconds - Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin - Pain, diaphoresis, and erythema - Jaundiced skin, weakness, and capillary refill of 3 seconds
Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin Rationale: Indicators of peripheral neurovascular dysfunction include pale, cyanotic, or mottled skin with a cool temperature; capillary refill greater than 3 seconds; weakness or paralysis with motion; and paresthesia, unrelenting pain, pain on passive stretch, or absence of feeling. Jaundice, diaphoresis, and warmth are inconsistent with peripheral neurovascular dysfunction. pg. 1109 ch. 35
A nurse is providing care for a client whose pattern of laboratory testing reveals long-standing hypocalcemia. Which other laboratory result is most consistent with this finding? - An elevated parathyroid hormone level - An increased calcitonin level - An elevated potassium level - A decreased vitamin D level
An elevated parathyroid hormone level Rationale: In the response to low calcium levels in the blood, increased levels of parathyroid hormone prompt the mobilization of calcium and the demineralization of bone. Increased calcitonin levels would exacerbate hypocalcemia. Vitamin D levels do not increase in response to low calcium levels. Potassium levels would likely be unaffected. pg. 1111 ch. 35
A public health nurse is organizing a campaign that will address the leading cause of musculoskeletal-related disability. The nurse should focus on what health problem? - Osteoporosis - Arthritis - Hip fractures - Lower back pain
Arthritis Rationale: The leading cause of musculoskeletal-related disability is arthritis. pg. 1097 ch. 35
A client has presented to the emergency department with an injury to the wrist. The client is diagnosed with a third-degree strain. Why would the health care provider prescribe an x-ray of the wrist? - Nerve damage is associated with third-degree strains. - Compartment syndrome is associated with third-degree strains. - Avulsion fractures are associated with third-degree strains. - Greenstick fractures are associated with third-degree strains.
Avulsion fractures are associated with third-degree strains. Rationale: An x-ray should be obtained to rule out bone injury because an avulsion fracture (in which a bone fragment is pulled away from the bone by a tendon) may be associated with a third-degree strain. Nerve damage, compartment syndrome, and greenstick fractures are not associated with third-degree strains.
A client has symptoms of osteoporosis and is being assessed during an annual physical examination. The assessment shows that the client will require further testing related to a possible exacerbation of osteoporosis. The nurse should anticipate which diagnostic test? - Bone densitometry - Hip bone radiography - Computed tomography (CT) - Magnetic resonance imaging (MRI)
Bone densitometry Rationale: Bone densitometry is considered the most accurate test for osteoporosis and for predicting a fracture. As such, it is more likely to be used than CT, MRI, or x-rays. pg. 1110 ch. 35
A clinic nurse is caring for a client with a history of osteoporosis. What diagnostic test will best allow the care team to assess the client's risk of fracture? - Arthrography - Bone scan - Bone densitometry - Arthroscopy
Bone densitometry Rationale: Bone densitometry is used to detect bone density and can be used to assess the risk of fracture in osteoporosis. Arthrography is used to detect acute or chronic tears of joint capsule or supporting ligaments. Bone scans can be used to detect metastatic and primary bone tumors, osteomyelitis, certain fractures, and aseptic necrosis. Arthroscopy is used to visualize a joint.
A client has had a cast placed for the treatment of a humeral fracture. The nurse's most recent assessment shows signs and symptoms of compartment syndrome. What is the nurse's most appropriate action? - Arrange for a STAT assessment of the client's serum calcium levels. - Perform active range of motion exercises. - Assess the client's joint function symmetrically. - Contact the primary provider immediately.
Contact the primary provider immediately. Rationale: This major neurovascular problem is caused by pressure within a muscle compartment that increases to such an extent that microcirculation diminishes, leading to nerve and muscle anoxia and necrosis. Function can be permanently lost if the anoxic situation continues for longer than 6 hours. Therefore, immediate medical care is a priority over further nursing assessment. Assessment of calcium levels is unnecessary.
A client injured in a motor vehicle accident has sustained a fracture to the diaphysis of the right femur. Of which tissue is the diaphysis of the femur mainly constructed? - Epiphyses - Cartilage - Cortical bone - Cancellous bone
Cortical bone Rationale: The long bone shaft, which is referred to as the diaphysis, is constructed primarily of cortical bone. pg. 1097 ch. 35
How often does the entire skeleton regenerate? - Every 5 years - Every 6 months - Every 10 years - Typically once you are 20 the skeleton does not regenerate
Every 10 years Rationale: This was mentioned during lecture. pg. 1098 ch. 35
A client is involved in a motorcycle accident and injures an arm. The health care provider diagnoses the man with an intra-articular fracture and splints the injury. The nurse implements the teaching plan developed for this client. What sequela of intra-articular fractures should the nurse describe regarding this client? - Posttraumatic arthritis - Fat embolism syndrome (FES) - Osteomyelitis - Compartment syndrome
Posttraumatic arthritis Rationale: Intra-articular fractures often lead to posttraumatic arthritis. Research does not indicate a correlation between intra-articular fractures and FES, osteomyelitis, or compartment syndrome.
A nurse on the orthopedic unit is assessing a client's peroneal nerve. The nurse should perform this assessment by doing what action? - Pricking the skin between the great and second toe - Stroking the skin on the sole of the client's foot - Pinching the skin between the thumb and index finger - Stroking the distal fat pad of the small finger
Pricking the skin between the great and second toe Rationale: The nurse will evaluate the sensation of the peroneal nerve by pricking the skin centered between the great and second toe. None of the other listed actions elicits the function of one of the peripheral nerves. pg. 1109 ch. 35
True or False: The Human body has 46 anatomic compartments?
True
atonic
without tone; denervated muscle that atrophies