Exam 3 M/S, Mobility

A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture? a)Closed b)Incomplete c)Stress d)Compression

Incomplete

hinge joint

Joint between bones (as at the elbow or knee) that permits motion in only one plane

ball and socket joint

The ball and socket joint is a type of synovial joint in which the ball-shaped surface of one rounded bone fits into the cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. This enables the joint to move in many directions

Which would be contraindicated as a component of self-care activities for the client with a cast? a)Cover the cast with plastic to insulate it b)Cushioning rough edges of the cast with tape c)Elevate the casted extremity to heart level frequently d)Do not attempt to scratch the skin under a cast

a)Cover the cast with plastic to insulate it

plane joint

allows only gliding movement. Plane joints permit sliding movements in the plane of articular surfaces

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

b)A fasciotomy

example of hinge joint

elbow and knee

Example of pivot joint

neck

saddle joint

type of joint found at the base of each thumb; allows grasping and rotation

example of condyloid joint

wrist

Arthrodesis is: a)fusion of a joint (most often the wrist or knee) for stabilization and pain relief. b)total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain. c)replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. d)cutting and removal of a wedge of bone (most often the tibia or femur) to change the bone's alignment, thereby improving function and relieving pain.

Arthrodesis is fusion of a joint (most often the wrist or knee) for stabilization and pain relief. Arthroplasty is total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain. Hemiarthroplasty is the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. Osteotomy is the cutting and removal of a wedge of bone (most often the tibia or femur) to change the bone's alignment, thereby improving function and relieving pain

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? a)"CPM increases range of motion of the joint." b)"CPM strengthens the muscles of the leg." c)"CPM delivers analgesic agents directly into the joint." d)"CPM prevents injury by limiting flexion of the knee."

a)"CPM increases range of motion of the joint."

A patient has a cast removed after bone healing takes place. What should the nurse instruct the patient to do after removal? (Select all that apply.) a)Apply an emollient lotion to soften the skin. b)Control swelling with elastic bandages, as directed. c)Gradually resume activities and exercise. d)Use friction to remove dead surface skin by rubbing the area with a towel. e)Use a razor to shave the dead skin off.

a)Apply an emollient lotion to soften the skin. b)Control swelling with elastic bandages, as directed. c)Gradually resume activities and exercise.

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse? a)Assess for complications. b)Assess for previous opioid drug use. c)Reposition the client for comfort. d)Teach relaxation techniques.

a)Assess for complications. Unrelieved pain can be an indicator of a complication, such as compartment syndrome. Previous opioid drug use should not influence a complete and thorough assessment. Repositioning the client for comfort may be appropriate once all indications of a complication are ruled out. It is appropriate to teach relaxation techniques to help ease the pain, but assessing for a complication remains the highest priority

A client with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? Select all that apply. a)Assess the fingers for color and temperature. b)Administer a prescribed analgesic to promote comfort and allay anxiety. c)Assess for a pressure sore d)Determine the exact site of the pain. e)Cut the cast with a cast saw

a)Assess the fingers for color and temperature. c)Assess for a pressure sore d)Determine the exact site of the pain.

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

a)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.

Which of the following is a term used to describe a soft tissue injury produced by a blunt force? a)Contusion b)Sprain c)Strain d)Hematoma

a)Contusion A contusion is a soft tissue injury produced by blunt force, such as a blow, kick, or fall, that results in bleeding into soft tissues (ecchymosis, or bruising). A hematoma develops when the bleeding is sufficient to form an appreciable solid swelling. A strain, or a "pulled muscle," is an injury to a musculotendinous unit caused by overuse, overstretching, or excessive stress. A sprain is an injury to the ligaments and supporting muscle fibers that surround a joint often caused by a trauma, wrenching or twisting motion.

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

a)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)

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture? a)Encourage participation in ADLs b)Promote intake of omega-3 fatty acids c)Use frequent dependent positioning to prevent edema d)Administer prescribed enema to prevent constipation

a)Encourage participation in ADLs

Which client(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply. a)The client with elevated pressure within the muscles b)The client with hemorrhage in the site of injury c)The client with a plaster cast applied immediately after injury d)The client who sustained a clavicle fracture e)The client using ice to control pain in the extremity

a)The client with elevated pressure within the muscles b)The client with hemorrhage in the site of injury c)The client with a plaster cast applied immediately after injury

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

a)The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes.

Which describes fracture of bone that has splintered into several fragments (couldnt upload pictures) a)comminuted b)impacted fracture c)transverse fracture d)compound fracture

a)comminuted fracture (Option A)Comminuted fracture is a bone that has splintered into several fragments. A fracture in which a bone fragment is driven into another bone fragment is called an impacted fracture (Option B). A transverse fracture (Option C) results in a break straight across the bone shaft. A fracture involving damage to the skin or mucous membranes is called an open or compound fracture (Option D).

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? a)Compound b)Greenstick c)Oblique d)Spiral

a)compound A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.

A client has a fractured femur and is being seen in the emergency department. The nurse assessing the area notices there is a grating sound that is suspected to be bone ends moving over one another. This would be called: a)crepitus. b)false motion. c)spasm. d)deformity.

a)crepitus Crepitus is the grating sound of bone ends moving over one another, which may be audible (this term also refers to a popping sound caused by air trapped in soft tissue). False motion is unnatural motion that occurs at the site of the fracture. Spasm is the involuntary contraction of the muscles near the fracture. Deformity describes the unusual position or bending backward assumed by the extremity due to the break.

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

b)"Place pillows between your legs when you lay on your side." c)"Avoid bending forward when sitting in a chair." d)"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

A client diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse? a)"This allows for the strength in the arm to remain consistent." b)"The joint above the fracture and below the fracture must be immobilized." c)"When a spica cast is ordered, the arm must be immobilized." d)"The method allows for the fastest healing time and the greatest mobility."

b)"The joint above the fracture and below the fracture must be immobilized." Generally, the joints proximal and distal to the fracture are immobilized to promote healing. The purpose is not for the strength to remain consistent; most clients will lose strength. A spica cast would not be ordered for an ulnar fracture. Although immobilizing the joints above and below fractures may shorten healing time, it does not allow for increased mobility.

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

b)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.

A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period? a)Neuroma b)Hematoma c)Chronic osteomyelitis d)Unexplainable burning pain (causalgia)

b)Hematoma

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? a)A dull, deep, boring ache b)Sharp and piercing c)Similar to "muscle cramps" d)Sore and aching

b)Sharp and piercing Pain associated with the underlying condition (e.g., fracture, which is sharp and piercing) is frequently controlled by immobilization.Pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can frequently be controlled by elevation and, if prescribed, intermittent application of ice or cold packs.Pain associated with compartment syndrome is relentless and is not controlled by modalities such as elevation, application of ice or cold, and usual dosages of analgesic agents. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer.

The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the: a)Condylar area. b)Femoral neck. c)Shaft of the femur. d)Trochanteric region.

b)femoral neck

example of plane joint

between the tarsal bones of the foot

Which factor inhibits fracture healing? a)Vitamin D b)Exercise c)Local malignancy d)Maximum bone fragment contact

c)Local malignancy

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

c)Pulmonary embolism

Which statement is accurate regarding care of a plaster cast? a)The cast must be covered with a blanket to keep it moist during the first 24 hours. b)The cast will dry in about 12 hours. c)The cast can be dented while it is damp. d)A dry plaster cast is dull and gray.

c)The cast can be dented while it is damp. The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding

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? a)Arthrodesis b)Hemiarthroplasty c)Total arthroplasty d)Osteotomy

c)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 hemiarthroplasty is 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.

Meniscectomy refers to the a)replacement of one of the articular surfaces of a joint. b)incision and diversion of the muscle fascia. c)excision of damaged joint fibrocartilage. d)removal of a body part.

c)excision of damaged joint fibrocartilage. The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint.

Which term refers to the failure of fragments of a fractured bone to heal together? a)Dislocation b)Subluxation c)Nonunion d)Malunion

c)nonunion When nonunion occurs, the client reports persistent discomfort and movement at the fracture site. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Malunion refers to growth of the fragments of a fractured bone in a faulty position, forming an imperfect union.

A nurse is caring for a client who recently underwent a total hip replacement. What is the best action by the nurse for client care? a)Ease the client onto a low toilet seat. b)Allow the client's legs to be crossed at the knees when out of bed. c)Use soft chairs when the client is sitting out of bed. d)Limit hip flexion of the client's hip when the client sits up.

d)Limit hip flexion of the client's hip when the client sits up. The nurse should instruct the client to limit hip flexion to 90 degrees when sitting. The nurse should supply an elevated toilet seat so that the client can sit without having to flex the hip more than 90 degrees. The nurse should instruct the client not to cross legs to avoid dislodging or dislocating the prosthesis. The nurse should caution the client against sitting in chairs that are too low or too soft; these chairs increase flexion, which is undesirable.

A client is in Buck's traction after fracturing his right hip. The nurse should include which action in the care plan? a)Removing the weights once every shift b)Maintaining the bed in the knee gatch position c)Keeping the client in semi-Fowler's position d)Maintaining correct body alignment

d)Maintaining correct body alignment

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? a)Arthrodesis b)Joint arthroplasty c)Total joint arthroplasty d)Open reduction

d)Open reduction An open reduction is the correction and alignment of the fracture after surgical dissection and exposure of the fracture. Arthrodesis is immobilizing fusion of a joint. A joint arthroplasty or replacement is the replacement of joint surfaces with metal or synthetic materials. A total joint arthroplasty is the replacement of both the articular surfaces within a joint with metal or synthetic materials.

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

d)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.

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? a)Apply the traction straps snugly. b)Assess the client's level of consciousness. c)Remove the traction at least every 8 hours. d)Teach the client how to prevent problems caused by immobility.

d)Teach the client how to prevent problems caused by immobility. By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removing skeletal traction is the physician's responsibility — not the nurse's.

pivot joint

freely moveable joint (diarthrosis) that allows only rotary movement around a single axis

condyloid joint

ovoid articular surface, or condyle that is received into an elliptical cavity. This permits movement in two planes, allowing flexion, extension, adduction, abduction, and circumduction.

example of ball and socket joint

shoulder and hip

example of saddle joint

thumb