Med - Surg Chap 62 practice

In which order should the nurse complete actions when caring for a patient in the emergency department who has a right leg fracture? 1. Obtain X-rays 2. Check pedal pulses 3. Assess lung sounds 4. Take blood pressure 5. Apply splint to leg 6. Administer tetanus prophylaxis

3 , 4 , 2 , 5 , 1 , 6.

Which action should the nurse take to evaluate the effectiveness of Buck's traction for a patient who has an intracapsular fracture of the right femur? A. assess for hip pain B. Check for contractures C. Palpate peripheral pulses D. Monitor for hip dislocation

A - Buck's traction is used to reduce painful muscle spasm.

What should the occupational health nurse advise a patient whose job involves many hours of typing? 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 non steroidal antiinflammatory drugs (NSAIDS)

A - Repetitive strain injuries caused by prolonged work at a keyboard can be prevented by using a pad to keep the wrists in a straight position.

For a patient who had a right hip arthroplasty, which nursing action can the nurse delegate to experienced UAP? a. Reposition patient every 1-2 hours b. Assess for skin irritation on the patient's back c. Teach the patient quadriceps-setting exercises d. Determine the patients pain intensity and tolerance

A - Repositioning of orthopedic patients is within the scope of practice of UAP after they have been trained and evaluated in this skill.

A patient who has an open reduction and internal fixation (ORIF) of a hip fracture tells the nurse he is ready to get out of bed for the first time. Which action should the nurse take? A. Check the patient's prescribed weight bearing status. B. Use a mechanical life to transfer the patient to the chair C. Decrease pain medication before getting the patient up D. Have the UAP transfer the patient.

A - The nurse should be familiar with the weight bearing orders for the patient before attempting the transfer.

A patient with a right lower leg fracture will be discharged home with an external fixation device in place. Which statement should the nurse include in discharge teaching? A. "Check and clean the pin insertion sites daily." B. "Remove the external fixator for your shower." C. "Remain on bed rest until bone healing is complete." D. "Take prophylactic antibiotics until the fixator is removed."

A - pin insertion sites should be cleaned daily to decrease risk for infection at the site

A patient who had open reduction and internal fixation (ORIF) of left lower leg fractures continues to report severe pain in the leg 15 minutes after receiving the prescribed IV morphine. The nurse determines pulses are faintly palpable and the foot is cool to the touch. 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 - the patient's clinical manifestations suggest compartment syndrome and delay in diagnosis and treatment may lead to severe functional impairment.

Which action should the urgent care nurse take for a patient with a possible knee meniscus injury? A. Encourage bed rest for 24-48 hours B. Apply an immobilizer to the affected leg C. Avoid palpation or movement of the knee D. Administer intravenous opioids for pain management

B - A knee immobilizer may be used for several days after a meniscus injury to stabilize the knee and minimize pain

After change-of-shift report, which patient should the nurse assess first? a. Patient with a repaired mandibular fracture who is reporting facial pain. b. Patient with repaired right femoral shaft fracture who reports tightness in calf. C. Patient with an unrepaired Colles' fracture who has right wrist swelling and deformity. D. Patient with an unrepaired intracapsular left hip fracture whose leg is externally rotated.

B - Calf swelling after a femoral shaft fracture suggests possible DVT or compartment syndrome.

A 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 begin work with a physical therapist tomorrow." c. "Keep the shoulder immobilizer on for the first 4 days to minimize pain." d. "The surgeon will use the drop-arm test to determine the success of surgery."

B - Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent "Frozen shoulder"

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 - The nurse should monitor for a postoperative hemorrhage.

Which statement by a patient who has had an above-the-knee amputation indicates the nurse's discharge teaching has been affective? A. "I should elevate my residual limb on a pillow 2-3 times a day." B. "I should lie 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 dry skin and cracking."

B - The patient lies in the prone position several times daily to prevent flexion contractures of the hip.

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 - The patient should be adequately medicated for pain before any attempt to ambulate.

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 patient's legs for swelling or tenderness. d. Notify the health care provider about the symptoms.

B - The patient's clinical manifestations and history are consistent with a pulmonary embolism, and the nurse's first action should be to ensure adequate oxygenation.

The nurse is caring for a patient who is using Buck's traction after a hip fracture. Which action can the nurse delegate to experienced UAP? A. Remove and reapply traction periodically B. Ensure the weight for the traction is hanging freely C. Monitor the skin under the traction boots for redness D. Check for intact sensation and movement in the affected leg.

B - UAP can be responsible for maintaining the integrity of the traction after it has been established.

a 60-yr-old patient had open reduction and internal fixation (ORIF) for an open, displaced tibial fracture. What should the nurse identify as the priority patient problem? A. Acute pain B. Risk for infection C. activity intolerance D. Risk for constipation

B - a patient having ORIF is at risk for problems such as wound infection and osteomyelitis.

The day after having a right below-the-knee amputation, a patient reports pain in the missing right foot. What action is most important for the nurse to take? A. explain the reasons for the pain B. Administer prescribed analgesics C. Reposition the patient to assure good alignment D. Tell the patient that the pain will diminish over time

B - acute phantom limb sensation is treated as any other type of postoperative pain would be treated.

The nurse should instruct a patient with a non displaced fractured left radius that the cast will need to remain in place for what amount of time? A. Two weeks B. At least 6 weeks C. Until swelling of the wrist has resolved D. Until x-rays show complete bony union

B - bone healing starts immediately after the injury, but because ossification does not occur until 3 weeks after injury, the cast will need to be worn for at least 3 weeks longer.

Which information about a patient with lumbar vertebral compression fracture should the nurse immediately report to the healthcare provider? A. Patient declines 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 - changes in bowel or bladder function indicate possible spinal cord compression and should be reported immediately because surgical intervention may be needed.

A patient who is to have no weight bearing on the left leg is learning to use crutches. Which observation by the nurse indicates 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 - patients are usually taught to move the crutches and the injured leg forward at the same time and then to move the unaffected leg.

A patient who arrives at the emergency department with severe left knee pain is diagnosed with a patellar dislocation. What should be the nurse's initial focus for patient teaching? a. Use of a knee immobilizer b. Monitored anesthesia care c. Physical activity restrictions d. Performance of gentle knee flexion

B - the first goal of interprofessional management is realignment of the knee to its original anatomic position, which will require anesthesia or monitored anesthesia care, formerly called conscious sedation

Which information should the nurse include in discharge teaching for a patient who has had a repair of a fractured mandible? 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 - the jaw will be wired for stabilization, and the patient should know what emergency situations require the wires to be cut to protect the airway.

The second day after admission with a fractured pelvis, a patient develops acute onset confusion. Which action should the nurse take first? a. Take the blood pressure. b. Assess patient orientation. c. Check pupil reaction to light. d. Assess the oxygen saturation.

B - the patients history and clinical manifestations suggest a fat embolism.

A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which assessment finding should indicate to the nurse a potential complication of the fracture? A. The patient states the pelvis feels unstable. B. The patient reports pelvic pain with palpation C. Abdomen is distended, and bowel sounds are absent D. Ecchymoses are visible across the abdomen and hips.

C - Abdomen distention and absent bowel sounds may be due to complications of pelvic fractures such as paralytic ileum or hemorrhage or trauma to the bladder, urethra, or colon.

Which patient statement indicates understanding of the nurse's teaching about a new short-arm synthetic cast? A. "I can remove the case in 4 weeks using industrial scissors" B. "I should avoid moving my fingers until the cast is removed." C. "I will apply an ice pack to the cast over the fracture site on and off for 24 hours." D. "I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast."

C - Ice application for the first 24 hours after a fracture will help reduce swelling and can be placed over the cast.

A patient is being discharged 4 days after hip arthroplasty using the posterior approach. Which patient action requires intervention by the nurse? A. using crutches with a swing-to gait B. sitting upright on the edge of the bed C. Leaning over to pull on shoes and socks D. Bending over the sink while brushing teeth

C - Leaning over would flex the hip at greater than 90 degrees and predispose the patient to hip dislocation

When a patient arrives in the emergency department with a facial fracture, which action should 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 patient's alertness and orientation

C - Patients who have facial fractures are at risk for cervical spine injury and should be treated as if they have a cervical spine injury until this is ruled out.

A patient is admitted to the emergency department with a left femur fracture. Which assessment finding by the nurse is most important to the healthcare provider? A. Bruising of left thigh B. Reports of severe thigh pain C. Slow capillary refill of the left foot D. Outward pointing toes on the left food

C - Prolonged capillary refill may indicate complications such as compartment syndrome

A pedestrian who was hit by a car is admitted to the emergency department with possible right lower leg fractures. What initial action should the nurse take? A. elevate the right leg B. splint the lower leg C. assess pedal pulses D. verify tetanus immunization

C - The initial nursing action should be assessment of the neurovascular condition of the injured leg.

The nurse is caring for a patient who has a pelvic fracture and an external fixation device. How should the nurse perform assessment of pressure areas and provide skin care to the patient's back and sacrum? A. ask the patient to turn to the side independently. B. Defer back assessment until the patient is ambulatory C. Have the patient lift the back and buttocks using a trapeze D. Roll the patient over to the side by pushing on the patient's hips.

C - The patient can lift the back slightly off the bed by using a trapeze.

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 - a shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency.

What should the nurse include when teaching older adults at a community recreation center about ways to prevent fractures? A. Tack down scatter rugs on the floor in the home B. Expect most falls to happen outside the home in the yard C. Buy shoes that provide good support and are comfortable to wear. D. Get instruction in ROM exercises from a physical therapist

C - comfortable shoes with good support willl help decrease the risk for falls.

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 - elevation of the leg will reduce swelling and pain.

Which information should the nurse include in discharge instructions for a patient with comminuted left forearm fractures and a long-arm cast? A. Keep the left shoulder elevated on a pillow or cushion B. Avoid NSAIDS C. Call the HCP for numbness of the hand D. Keep the hand immobile to prevent soft tissue swelling

C - increased swelling or numbness may indicate increased pressure at the injury, and the health care provider should be notified immediately to avoid damage to nerves and other tissues

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 - the axilla can become excoriated when a sling is used to support the arm, and the nurse should check the axilla and apply absorbent dressings to prevent this.

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 - the goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process

After a motorcycle accident, a patient arrives in the emergency department with severe swelling of the left lower leg. Which action will the nurse take first? a. Elevate the leg on 2 pillows. b. Apply a compression bandage. c. Assess leg pulses and sensation. d. Place ice packs on the lower leg.

C - the initial action by the nurse will be to assess circulation to the leg and observe for any evidence of injury such as fractures or dislocation.

After the health care provider recommends amputation for a patient who has non healing 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 - the initial nursing action should be to assess the patient's knowledge and feelings about the available options.

Which finding in a patient with a Colles' 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 - Swelling, pain, and deformity are common findings with a Colles' fracture.

A patient has possible right carpal tunnel syndrome. What symptom should the nurse expect with a positive Tinel's sign? A. Weakness in the right little finger. B. Burning in the right elbow and forearm C. Tremor when gripping with the right hand D. Tingling in the right thumb and index finger.

D - Testing for Tinel's sign will cause tingling in the thumb and first three fingers of the affected hand in patients who have carpal tunnel syndrome

A patient is to be discharged from the hospital 4 days after insertion of a femoral head prosthesis using a posterior approach. Which patient statement to the nurse indicates that additional teaching is needed? 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 to me"

D - The patient needs to sleep in a position that prevents excessive internal rotation or flexion of the hip.

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 - Treatment for repetitive strain syndrome includes changing the ergonomics of the activity.

Which action should the nurse include in the plan of care for a patient who had a cemented right total 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 - after knee arthroplasty, active or passive flexion exercises are used to obtain a 90 degree flexion of the knee

A young adult arrives in the emergency department with ankle swelling and severe pain after twisting an ankle playing basketball. Which prescribed action will the nurse implement first? A. send the patient for ankle x-rays B. administer naproxem C. Give acetaminophen with codeine D. Wrap the ankle and apply an ice pack

D - immediate care after a sprain or strain injury includes application of cold and use of compression too minimize swelling