Med Surg Exam

symptoms of compartment syndrome

-Pain unrelieved by medication (6 Ps)-Decr movement-Sluggish capillary refill-Paresthesia-Numbness below cast-Weak pulses-Coolness-Pallor-irreversible neuromuscular damage 4-6 hrs-limb useless in 24-48 hrs (48 hrs can cause foot drop)can measure pressure by inserting a needle, wick, slit catheter-pressure should be within 10-20mmHg of clients diastolic BP

A client sustains an open fracture of the left femur. An intramedullary pin is inserted, and the client is placed in skeletal traction. While performing the initial assessment, the nurse finds the client has slipped down toward the foot of the bed and the traction weight is resting on the floor. The appropriate nursing action is to...1. remove the weight and move the client to the correct alignment in bed.2. check for movement of the toes in the left foot.3. notify the attending orthopedic physician.4. help the client use the trapeze to pull himself up in bed.

..help the client use the trapeze to pull himself up in bed.The traction is no longer effective when it is resting on the floor. Provided that nothing is out of alignment, the nurse should help the client resume his normal position in bed to reestablish traction.1. besides causing pain, this could interfere with the correct alignment of the extremity. 2. checking the toes for movement is not an appropriate action at this time. 3. its not necessary to notify the orthopedic physician unless the traction is out of alignment or other assessments are not within normal range.

8 Complications of fractures

1. compartment syndrome2. fat embolism3. arterial damage can produce avascular necrosis4. infection with tetanus or gas gangrene5. shock6. volkmann's contractures7. nonunion8. venous thromboembolism (VTE)

3. wear elastic socks on both legs until I am discharged."The purpose of elastic stockings is to prevent thrombophlebitis, which is a common complication following orthopedic surgery. Thromboemboli can occur up to 6 months after surgery, so it is possible that the client will wear them even after discharge.1. a continuous passive motion machine is usually prescribed for a few hrs at a time for a total of 8 to 12 hr a day. 2. client should ask for pain medication before the pain becomes severe. this will lessen the amount needed and help keep them comfortable. 4. ambulation usually begins 48 hr following a total knee arthroplasty.

A client has been admitted to the orthopedic floor to have a right total knee arthroplasty performed. Which of the following statements demonstrates to the nurse that the client understands the preoperative teaching? "I will...1. have my knee placed in a continuous passive motion machine for 24 hours a day."2. ask for pain medicine whenever the pain gets bad."3. wear elastic stockings on both legs until I am discharged."4. have to stay in bed for a week after my surgery."

Shortening of the right legOne of the classic indicators of prosthetic dislocation is shortening of the affected leg, along with an inability to move it, abnormal rotation, and increased discomfort.

A client is 3 days postoperative following a right total hip arthroplasty. The client cries out in pain when transferred to a chair. Which of the following nursing observations should lead to the suspicion of a dislocated hip prosthesis?1. Bulging in the right hip area2. Shortening of the right leg3. Adduction of the left leg4. External rotation of the right leg

..coldness of the toesDecreased venous return from the constriction caused by a cast may lead to impaired circulation of the foot. Manifestations of impaired circulation include toes that are cold, numb, tingling, or swollen.2, 3: assessments indicate adequate circulation. 4. assessment is normal following an open reduction & internal fixation of a fracture. while pain may be more severe in the client w/ impaired circulation, pain alone is not an adequate assessment to make this determination.

A client is discharged after having an open reduction and internal fixation of a fractured tibia with application of a plaster cast. The nurse teaches the client to evaluate for early signs of decreased circulation related to post surgical edema. The nurse demonstrates that the teaching was understood when the client identified a manifestation of decreased circulation as..1. coldness of the toes.2. capillary refill of 3 seconds. 3. blanching of the nailbeds with pressure. 4. pain at the surgical site.

pulmonary embolus- A client who has had a fracture and is maintained on bed rest is at high risk for pulmonary emboli due to venous stasis & hypercoagulation. The typical presentation of a client with a blood clot in the arterial structure of the lung includes difficulty breathing, low blood pressure, & confusion. The clot occludes pulmonary arterial blood flow to the lung, resulting in hypoxia.1. While pneumonia can be a complication of immobility following a pelvic fracture, it does not cause a sudden onset of difficult breathing or a rapid drop in the oxygen saturation rate.3. Tension pneumothorax can produce sudden dyspnea, but the client hx given does not lead one to suspect a collapsed lung. Generally, clients with tension pneumothorax have a trachea that deviates away from the affected side & breath sounds are absent over the affected area.4. Flail chest results from multiple rib fractures. The client will have rapid, shallow respirations, a rapid heart rate, & develop cyanosis. Paradoxical chest movements that result from rib fractures will be obvious on visual inspection.

A client is on bed rest following a pelvic fracture when he suddenly becomes dyspneic and reports feeling short of breath. The nurse assesses the client and finds that tachycardia, hypotension, and tachypnea are occurring. The client's oxygen saturation level is dropping rapidly. The nurse should identify that the client is exhibiting signs consistent with..1. pneumonia.2. pulmonary embolus.3. tension pneumothorax.4. flail chest.

..use a hair dryer on a cool setting to blow air into the cast.The cool air will cause vasoconstriction and decrease neural transmission of sensation to the affected area.Objects should not be placed under the cast because they can break off and become lodged in the cast, causing an alteration in skin integrity.

A client with a radial fracture reports itching under the casted area. The appropriate nursing action to relieve itching is to..1. use a hair dryer on a cool setting to blow air into the cast.2. elevate the affected extremity.3. provide a cotton swab to scratch the area.4. explain to the client that itching is an indication the fracture is healing.

A. Open reduction carries a higher risk of infection (surgery, duh!)

A new med-surg nurse is discussing reduction procedures. Which of the following statements made by her requires further teaching?A. "Closed reduction carries a higher risk of infection"B. "Open reduction may require the use of continuous passive motion (CPM) machines."C. "The patient should have anesthesia for both closed and open reduction."D. "Closed reduction is a non-surgical option."

A knee joint arthroplasty is surgery to replace a painful, damaged, or diseased knee joint with a prosthetic joint. The nurse should complete the client assessment before selecting a course of action regarding the pain. The nurse should determine the characteristics of the client's pain and the frequency with which the client is using the PCA device before deciding what the next best action is. When caring for clients, assessment always comes first, followed by analysis, planning, intervening, and finally evaluating.

A night shift nurse is assigned to care for a client who is 12 hr postoperative following a total knee arthroplasty. The nurse finds the client's leg in a continuous passive motion machine, a drain attached to an evacuator unit is in place, and the client has a PCA device. The client reports to the nurse, "I am in so much pain." The nurse's first action at this time is to...1. suggest that the client push the button for the PCA device.2. reposition the client for increased comfort per the client's instruction.3. complete the assessment of the client including the client's pain.4. turn off the continuous passive motion machine until the pain improves.

Fat embolism syndrome-----The nurse should identify the triad of neurologic changes, petechial rash, and hypoxemia as findings of fat embolism syndrome. Risk factors include multiple fractures and fracture of a long bone. Male clients are also at greater risk. The manifestations occur when fat globules occlude small blood vessels.

A nurse in the emergency department is assessing a client who was in a motor-vehicle crash 2 days ago and sustained fractures to his tibia, ulna, and several ribs. The client is now disoriented to time and place, has a SaO2 of 87%, and the nurse notes generalized petechiae on the client's skin. Which of the following complications should the nurse suspect?

Apply cold compresses to the extremity intermittently.------Cold minimizes swelling and erythema to the affected area. Therefore, the nurse should instruct the client to apply cold compresses for no more than 20 min at a time.

A nurse in the emergency department is preparing to discharge a client following a Grade II (moderate) ankle sprain. Which of the following instructions should the nurse plan to give to the client?

TophiAcute gouty arthritis is a metabolic disease marked by uric acid deposits in the joints. The disorder causes painful gouty arthritis, especially in the joints of the feet & legs. Tophi are deposits of urate crystal deposits that occur on the hands, knees, feet, forearms, & the Achilles tendons in a client with chronic gout.1. Fluctuant subcutaneous nodules are a swelling under the skin that contain fluid.2. Heberden's nodes & enlarged joints are manifestations of osteoarthritis. Heberden's nodes are hard nodules or bony swellings, which develop around the distal interphalangeal joints.4. A boutonniere deformity is an inflammation of the finger tendons seen in rheumatoid arthritis which results in a permanent deformity of the phalanges.

A nurse is admitting a client with a history of gout. Which of the following manifestations should the nurse expect to find on the client's admission physical assessment?1. Fluctuant subcutaneous nodules2. Heberden's nodes3. Tophi4. Boutonniere deformity

Report of muscle spasms-----The nurse should consider Maslow's hierarchy of needs, which includes five levels of priority. The first level consists of physiological needs; the second level consists of safety and security needs; the third level consists of love and belonging needs; the fourth level consists of personal achievement and self-esteem needs; and the fifth level consists of achieving full potential and the ability to problem solve and cope with life situations. When applying Maslow's hierarchy of needs priority-setting framework, the nurse should review physiological needs first. The nurse should then address the client's needs by following the remaining four hierarchal levels. It is important, however, for the nurse to consider all contributing client factors, as higher levels of the pyramid can compete with those at the lower levels, depending on the specific client situation. The fourth level of Maslow's hierarchy of needs includes usefulness, self-worth, and self-confidence in fulfilling self-esteem needs. Therefore, the nurse should identify the report of muscle spasms, a physiological need, as the priority client finding.

A nurse is assessing a client who is 24 hr postoperative following an above-the-elbow amputation. Which of the following findings should the nurse identify as the priority?

Toes cold to the touch------The nurse should monitor for and report manifestations of compartment syndrome following internal fixation. Therefore, the nurse should contact the provider immediately if the client's toes are cold to the touch.

A nurse is assessing a client who is 48 hr postoperative following open reduction and internal fixation of a fractured tibia. Which the following findings should the nurse report to the provider?

Paresthesias of the extremity------The nurse should identify paresthesias as a finding of compartment syndrome. Compartment syndrome involves the compression of nerves and blood vessels in an enclosed space, leading to impaired blood flow and nerve damage. Other findings include numbness, tingling, weakness, and pain that does not respond to medication.

A nurse is caring for a client immediately following application of a plaster cast. The nurse should monitor for and report which of the following findings as an indication of compartment syndrome?

..an actual pain sensationThe nurse should recognize that the client is reporting phantom limb pain. Phantom limb pain is related to severed nerve pathways and is a frequent complication in clients who experience limb pain prior to the amputation. Phantom limb pain occurs less frequently following traumatic amputation. The nurse should recognize the pain is real and manage it accordingly. It may be described as deep and burning, cramping, shooting, or aching. Symptoms may be managed with various medications, such as opioids, antispasmodics, antiepileptics, or beta blockers.

A nurse is caring for a client who had a below the knee amputation for gangrene of the foot. The client knows that the foot has been amputated, but reports to the nurse severe pain in the toes of the injured foot. The nurse should recognize this as...1. an actual pain sensation.2. a delusional belief.3. a referred postoperative incisional pain.4. a defense mechanism of denial. this as ..

"This type of pain usually decreases over time as the limb becomes less sensitive."-----The nurse should recognize that the client is reporting phantom limb pain, a frequent complication following amputation. The nurse should instruct the client that the sensation should decrease over time. The nurse should recognize the pain, provide treatment, and handle the limb gently to decrease the risk of triggering pain.

A nurse is caring for a client who had a below-the-knee amputation for gangrene of the right foot. The client reports sensations of burning and crushing pain in the toes of the right foot. Which of the following statements should the nurse make?

Use a hair dryer on a cool setting to blow air into the cast.------The nurse should provide relief for the report of itching by blowing cool air into the cast using a hair dryer on a cool setting or an empty 60-mL plunger syringe.

A nurse is caring for a client who had a fiberglass cast placed on her left arm several hours ago and now reports itching under the cast. Which of the following actions should the nurse plan to take?

Pulmonary embolus-----Immobility following musculoskeletal trauma places the client at an increased risk for pulmonary embolus. The client might also exhibit tachycardia, chest petechiae, and have a decreased SaO2. The nurse should notify the rapid response team immediately.

A nurse is caring for a client who has a pelvic fracture. The client reports sudden shortness of breath, stabbing chest pain, and feelings of doom. The nurse should identify that the client is experiencing which of the following complications?

Shortening of the right leg-----The nurse should monitor the client for shortening of the affected leg as an indication of dislocation of the prosthesis. Other findings include increased hip pain, inability to move the extremity, and rotation of the hip internally or externally.

A nurse is caring for a client who is 3 days postoperative following a right total hip arthroplasty. While transferring to a chair, the client cries out in pain. The nurse should assess the client for which of the following manifestations of dislocation of the hip prosthesis?

Have the client use a trapeze to pull himself up while ensuring the weight hangs freely.-----The nurse should ensure that traction weight is hanging freely. The client can use an overhead trapeze bar to move up in bed, or the nurse can assist the client up, making sure to maintain proper alignment of the extremity.

A nurse is caring for a client who is in skeletal traction following a femur fracture. The nurse finds the client has slid down toward the foot of the bed and the traction weight is resting on the floor. Which of the following actions should the nurse take?

Ask the client to describe the characteristics of the pain.------Answering this item requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider of a change in the client's status, she must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with knowledge to make an appropriate decision. Therefore, the first action the nurse should take is to acquire further data by asking the client to describe the characteristics of the pain.

A nurse is caring for a client who is postoperative following a total knee arthroplasty and is prescribed a continuous passive motion (CPM) machine and PCA. The client tells the nurse, "I am in so much pain." Which of the following actions should the nurse take first?

"Hold your arm against the side of your body."-----Adduction means to position toward the midline of the body. Therefore, the nurse should provide these instructions to explain the provider's prescription.

A nurse is caring for a client who is postoperative following shoulder surgery. The client has a prescription to keep the affected arm adducted. Which of the following instructions should the nurse provide the client?

1. Risk for hemorrhageAccording to Maslow's hierarchy, physiological needs must be met first. Amputation following a traumatic injury to the leg will likely involve severing & repairing major blood vessels. The client is at a high risk for injury or hemorrhage.2. Preventing complications of immobility are important, however, using the airway, breathing, circulation (ABC) priority setting framework, observing for hemorrhage is the highest priority. It also poses the greatest risk to the client at this time as complications of immobility are currently potential and not actual problems.3. Many postoperative clients do have at least some impaired ability to perform self-care, but according to Maslow's, this is a higher level need. The client's physiological needs should be addressed first.4. Clients who experience a traumatic injury or amputation will have body image disturbance, but according to Maslow's, this is a higher level need. The client's physiological needs should be addressed first.

A nurse is caring for a client who sustained a traumatic injury to the leg in a farming accident resulting in amputation. Following an above-the-knee amputation, which of the following is the highest priority in the client's immediate postoperative care?1. Risk for hemorrhage2. Complications of immobility3. Inability to perform self-care4. Altered body image

"Osteoarthritis can impair a joint on a single side of the body."------The nurse should identify unilateral joint involvement as a finding of osteoarthritis. A client who has RA experiences symmetrical joint impairment.

A nurse is discussing the difference between rheumatoid arthritis (RA) and osteoarthritis with a newly licensed nurse. Which of the following information should the nurse include about osteoarthritis?

"Your provider might prescribe a central catheter line for long-term antibiotic therapy."-------Osteomyelitis is an acute or chronic bone infection. The client will require weeks to months of IV antibiotic therapy for treatment. Therefore, the nurse should discuss the need for long-term IV access for antibiotic therapy.

A nurse is discussing the plan of care with a client who has osteomyelitis of an open wound on his heel. Which of the following information should nurse include?

Celecoxib------Celecoxib is a type of NSAID, called cyclooxygenase-2 (COX-2) inhibitors, used to relieve some of the manifestations caused by RA in adults. The nurse should identify that the medication is also prescribed for osteoarthritis, spondylitis, and painful menstruation.

A nurse is performing medication reconciliation for a newly admitted client who has rheumatoid arthritis (RA). Which of the following medications should the nurse identify as the treatment for this condition?

Cut the wiring if emesis occurs.-----Inner maxillary fixation involves wiring of the teeth to support the fractured jaw by holding the jawbones together. The wires are left in place until the fracture is healed. To preserve the client's airway, the nurse should instruct the client to have wire cutters available to immediately cut wiring if emesis occurs. The client should return to the provider as soon as possible for re-wiring.

A nurse is providing discharge instructions for a client who is postoperative following inner maxillary fixation with wiring. Which of the following information should the nurse include?

"I should wear elastic stockings on both of my legs."------The purpose of elastic stockings is to prevent venous thromboembolism, which is a common complication following orthopedic surgery. Therefore, the nurse should identify this statement as understanding of the teaching.

A nurse is providing preoperative teaching for a client who is scheduled for total knee arthroplasty. Which of the following statements by the client should the nurse identify as understanding of the teaching?

Aspirin-----Aspirin can decrease the effectiveness of probenecid. The nurse should caution the client to avoid interaction between probenecid and salicylate medications.

A nurse is reviewing the medical record of a client who has a prescription for probenecid to treat gout. The nurse should identify that which of the following medications can interact with probenecid?

History of anorexia nervosa-----The nurse should identify anorexia nervosa as a risk factor for osteoporosis. Inadequate protein intake can lead to a decreased bone density, increasing the risk for fractures

A nurse is reviewing the medical record of a female client. Which of the following findings should the nurse identify as a risk factor for osteoporosis?

"I will sit upright after taking the medication."-----A client taking alendronate should sit upright for 30 min after administration to prevent esophageal irritation and ulceration. Therefore, the nurse should identify this statement as indicating an understanding of the teaching.

A nurse is teaching a client who has a new prescription for alendronate for treatment of osteoporosis. Which of the following statements by the client indicates understanding of the teaching?

C. Put a gait belt on the patient and stand on the same side of the bed as the affected leg

A patient is postoperative for a total hip arthroplasty and needs to get out of bed for the first time. What should the nurse do?A. Schedule an appointment for the therapist to assist the patientB. Caution unlicensed assistive personnel about fall prevention and instruct to observe for dizzinessC. Put a gait belt on the patient and stand on the same side of the bed as the affected legD. Ask the patient how much assistance is needed to stand and pivot into the chair

2. localized."Osteoarthritis is a deterioration of cartilage & overgrowth of bone. Rheumatoid arthritis is the inflammation of a joint's connective tissues, such as the synovial membranes, which leads to the destruction of the articular cartilage. Osteoarthritis is a localized process associated with aging and can affect any joint. The cartilage of the affected joint is gradually worn down, eventually causing a bone to rub against another bone. Joints appear larger, are stiff and painful, and usually feel worse the more they are used throughout the day.1. Rheumatoid arthritis is a systemic autoimmune disease in which the body's immune system attacks itself. The pattern of joints affected is usually bilateral, involving the hands and other joints, & is worse in the morning.3. Rheumatoid arthritis is a systemic autoimmune disease, involving other body organs, whereas osteoarthritis is limited to the joints.4. Osteoarthritis is a deterioration of cartilage & overgrowth of bone. RA is the inflammation of a joint's connective tissues which leads to the destruction of the articular cartilage. Rheumatoid arthritis usually affects the same joints bilaterally, while osteoarthritis affects a joint, independent of other joints.

An assisted personnel at an extended care facility asks a nurse the difference between rheumatoid arthritis and osteoarthritis. The nurse responds, "Osteoarthritis is...1. autoimmune."2. localized."3. systemic."4. bilateral."

C. NEVER disrupt skeletal traction unless life threatening.

As a nursing student, you are assigned a patient with skeletal traction. You walk into your patient's room and they say "This traction is killing me, it's so painful! Can you please just remove it for like 10 minutes?" How do you reply?A. "Sure, but let me go get my nurse first since I'm only a student."B. "I can, but I need to get your blood pressure first to make sure you won't have orthostatic hypotension."C. "I'm sorry, we can't remove it unless there's an emergency."D. "The traction needs to fall off on its own. Within 48 hours, your pain should be relieved."

Numbness and tinglingCompartment syndrome involves the compression of nerves & blood vessels within an enclosed space, leading to impaired blood flow & nerve damage. Thick layers of tissue called fascia separate groups of muscles in the arms & legs from each other. Inside each layer of fascia is a confined space, called a compartment, that includes the muscle tissue, nerves, & blood vessels. Bc fascia do not expand, any swelling in a compartment will lead to increasing pressure in that compartment, which will compress the muscles, blood vessels, & nerves. If this pressure is high enough, blood flow to the compartment will be blocked, which can lead to permanent injury to the muscle & nerves. The hallmark symptom of compartment syndrome is severe pain that does NOT respond to elevation or pain medication. In more advanced cases, there may be numbness, tingling, weakness, & paleness of the skin.

During report, a nurse is told to assess a client who was recently casted for a radial fracture for compartment syndrome. For which of the following findings should the nurse assess?1. Decreased range of motion of the fingers distal to the cast2. Numbness and tingling3. Cyanosis of the fingers distal to the cast4. Elevated client temperature

A. Older patient who has trouble with mobility at baselineB. Obese patient with chronic pain associated with rheumatoid arthritisC. Patient with a previous history of VTE related to job as a truck driverE. Patient with compromised circulation secondary to sickle cell disorder

Following a total joint arthroplasty, which patients have a higher risk of venous thromboembolism (VTE)? SATAA. Older patient who has trouble with mobility at baselineB. Obese patient with chronic pain associated with rheumatoid arthritisC. Patient with a previous history of VTE related to job as a truck driverD. Thin patient who needs medication for hyperthyroidismE. Patient with compromised circulation secondary to sickle cell disorder F. Patient with a history of osteoarthritis pain that is treated with acetaminophen

3. close to the bodyAdducted means to position the arm toward the midline, or adjacent part, of the body. By keeping the arm close to the body, the shoulder joint is properly kept adducted.1. Bent at the elbow: This action refers to flexion. While it is possible that flexion of the elbow may also be prescribed, this does not explain adduction.2. Positioned on two pillows: This action refers to elevation. This does not explain adduction.close to the body.4. With the shoulder at a 90º angle. This action refers to abduction, moving the arm away from the midline of the body.

Following shoulder surgery, a client is instructed to keep the arm adducted at all times. The nurse explains to the client that this means he must keep the arm..1. bent at the elbow.2. positioned on two pillows.3. close to the body.4. with the shoulder at a 90º angle.

Rheumatoid arthritisCelecoxib is a nonsteroidal anti-inflammatory, cyclooxygenase-2 (COX-2) inhibitor, used to relieve some manifestations caused by rheumatoid arthritis in adults.

On a health history form, a client being admitted to an outpatient surgery center for a knee arthroscopy indicates taking celecoxib (Celebrex) daily. Based on the medication, the nurse should expect that the client has a history of1. infection.2. depression.3. rheumatoid arthritis.4. seizures.

A. Document the drainage and continue to observe the site and drainage every 4 hours

The nurse assesses the patient's surgical hip site and measures the drainage every 4 hours. At 0700 there is 30 mL in the drainage container; at 1100 there is 10 mL; at 1500 there is 5 mL; at 1900 there is 20 mL. What should the nurse do?A. Document the drainage and continue to observe the site and drainage every 4 hoursB. Take vital signs, observe the site for signs of hemorrhage, and notify the surgeonC. Document the findings but change the assessment frequency to every 2 hoursD. Ask the patient if there is increased pain or decreased sensation on the affected side

broad spectrum antibiotic such as IV cefazolin

The nurse is providing care for a patient scheduled for a total hip arthroplasty. Which medication should the patient receive one hour before the surgical incision in accordance with the Surgical Care Improvement Project Core Measures?A. Low-molecular-weight heparin, such as subcutaneous enoxaparinB. Fast-acting opioid, such as IV morphineC. Broad-spectrum antibiotic, such as IV cefazolinD. Routine daily dose of oral antihypertensive

D. Subcutaneous low-molecular-weight heparin (LMWH)

To prevent venous thromboembolism, several types of anticoagulant medications can be ordered. Which drug is most commonly used during hospitalization?A. Oral or parenteral aspirinB. Oral warfarinC. Intravenous tissue plasminogen activator (tPA)D. Subcutaneous low-molecular-weight heparin (LMWH)

A, DPatient should NOT have a decrease in bowel sounds (cast syndrome)Reposition every 2-3 hours while drying.

Which of the following are correct statements about body casts? SATA.A. Cast syndrome can occur if the cast is too tightB. It is normal for these patients to have hypoactive bowel sounds.C. Reposition this patient every 24 hours while it dries.D. Nausea/vomiting can occur with cast syndrome.

A, D Used to prevent/reduce muscle spasms, used to expand a joint before major joint reconstruction or during arthroscopic procedures

Which of the following are not purposes of traction? SATA.A. Inducing muscle spasms to encourage re-alignment.B. Immobilizing a jointC. Preventing soft tissue damageD. Reduce a joint before major joint reconstructionE. Treat a pathological joint condition.

B Constipation is!

Which of the following is NOT a systemic complication of immobilization?A. Skin breakdownB. DiarrheaC. Orthostatic hypotensionD. Kidney stones

D Just wanted to emphasize that infection could lead to osteomyelitis!!!

While assessing your skeletal traction patient, you notice yellow drainage and swelling at the pin sites. As a super smart nursing student, you know that this could lead to....A. Diabetes mellitusB. Avulsion fractureC. Turner syndromeD. Osteomyelitis

B Don't use the spacer bar to turn her.

You are discussing care with a parent of a child with hip dysplasia. Which of the statements given by the parent indicate a need for further teaching about hip spica casts?A. "This cast will help keeps my child's legs aligned."B. "I will use the spacer bar to turn over on her side."C. "I will make sure she does not lie on her abdomen"

C

Your 16 year old patient came to the emergency department with a tibia fracture. He said he hurt his leg doing a skateboard trick 30 minutes ago. Should you be worried about a fat embolism?A. "Yes, there is risk of fat embolism from the time of injury until 48 hours after."B. "Yes, until the bone is healed, fat embolism is a major concern."C. "No, they generally occur 12-72 hours after the injury."D. "No, fat emboli are not a risk in patients this young."

B. Injured knees should be examined within 24 hours of injury.Risk of quadriceps atrophy!Stretching is only good for prevention!

Your 16-year-old neighbor comes to you with a question, knowing that you are a nurse. She asks "I hurt my knee in my basketball game a few hours ago. It keeps popping and it really hurts. What should I do?" You reply saying....A. "Elevate your knee and ice it. If it still hurts in 2 days, go see your doctor."B. "Go see your doctor as soon as possible."C. "You probably fractured your knee. Let me put on a cast for you!"D. "Try doing some stretches before you work out tomorrow. That should help."

A Neurovascular assessments at least every 4 hours!Skin traction only has 5-10 lb., shouldn't be adjusted anyway. Do not just remove traction without physician's orders.Should not be turning and messing with the traction!

Your patient had a femoral fracture and has skin traction. Which of the following can you perform in caring for this patient?A. Neurovascular assessments every 2 hoursB. Adjusting the 60 lb. weight every 2 hoursC. Remove boot every shift for at least 15 minutes.D. Have the patient turn every 2 hours.

A, D, EShould NOT use RICE with compartment syndrome.Neurovascular assessments can help prevent fasciotomy (high risk of infection) and amputation!

Your patient is experiencing pain, and increased pressure in his lower leg after being treated for a fracture. It is not relieved by opioids, and you cannot palpate a pedal pulse. Which of the following interventions may be done? SATA.A. Removal of castB. Elevation the legC. Ice the legD. FasciotomyE. Amputation

i plan to use a walker to help me get arounddo not place a pillow under the knee

a home health nurse is performing an assessment on a client who is 1 week postoperative following a total knee replacement. which of the following statements by the client indicates an understanding of the teaching

applying warm compresses to sore joint

a nurse in an acute care clinic is talking with a client who reports that the osteoarthritis pain in her knees is increasing each day. the client wants to discuss non-pharmacological approaches to help relieve her pain. which of the following interventions should the nurse suggesta. applying warm compresses to sore jointb. decreasing the daily intake of dietary proteinc. keeping joint in extension during test periodsd. limiting sleep to 6-7 hr per night

apply cold compresses to the extremity intermittentlyperform passive range of motion hourlyelevate the extremetyapply compression dressing all to reduce swelling

a nurse in an emergency department is preparing to discharge a client following grade 11 (moderate) ankle sprain. which of the following instructions should the nurse plan to give to the client

fat embolism syndrome

a nurse in the emergency department is assessing a client who has in a motor vehicle crash 2 days ago and sustained fractures of his tibia, ulna, and several ribs. the client is now disoriented to time and place and has a SAO2 of 87%. the nurse notes generalized petechiae on the client's skin. which of the following complications should the nurse suspecta.hypovolemic shockb. fat embolism syndromec. thrombophlebitisd. avascular bone necrosis

check neurovascular status distal to the injury

a nurse in the emergency department is caring for a client who reports pain in her left leg following a motor-vehicle crash. the client's left leg has bruising, swelling, and displacement of the bones. which of the following actions should the nurse take firsta. obtain an xray of the injured legb. apply ice packs to the affected areac. check neurovascular status distal to the injuryd. elevate the affected leg on 2 pillows

chest petechiae

a nurse is assessing a client who has a fractured left femur and is in skeletal traction. which of the following findings should the nurse report to the providera. ecchymosis of the thighb. serous drainage at the pin sitec. chest petechiaed. muscle spasm in the left leg

hard lumps over the joint of the finger

a nurse is assessing a client who has osteoarthritis. the client's medical record indicates the presence of hebenden's nodes. which of the following findings should the nurse expect?a. inflamed, fluid-filled sacs over the jointsb. clubbing of the fingernailsc. flexion contracture of the fingersd. hard lumps over the joint of the fingers

lower back pain

a nurse is assessing a client who has several risk factors for osteoporosis. which of the following findings indicates that the client require futher evaluation for this disordera. leg cramps with exerciseb. stress incontinencec. abdominal distentiond. lower back pain

client report of muscle spasms

a nurse is assessing a client who is 24 hr postoperative following an above-the-elbow amputation. which of the following findings should the nurse identify as the prioritya. client report muscle spasmsb. inability to get dressed without assistancec. client report of feelings of angerd. refusal to look at the affected limb

toes that are cold to touch

a nurse is assessing a client who is 48 hr postoperative following open reduction and internal fixation of a fractured tibia. which of the following findings should the nurse report to the providera. toes that are cold to touchb. serous drainage from the pin sites c. blanching of the toenail bed with pressured. pink tissue around the fixator insertion sites

standing behind the client, who is bent over at waist

a nurse is assessing a client's skeletal system. the nurse should be in which of the following positions to screen the client for scoliosis

diuretic use

a nurse is assessing a female client who report severe joint pain. the nurse should identify that which of the following factors places the client at risk for gouta. perimenopaauseb. migraine headaches c. diuretic used. irritable bowel syndrome

to prevent dislocation of the hip during position changes or movement

a nurse is caring for a client following a hip arthroplasty. the nurse places an abduction pillow on the client for which of the following purposes

parenthesias of the extremity

a nurse is caring for a client immediately following application of a plaster cast. the nurse should monitor for and report which of the following findings an an indication of compartment syndromea. sensation of heat on the surface of the castb. parenthesias of the extremity c. pruritus of the extremityd. musty odor noted from cast materials.

this type of pain usually decreases over time as the limb becomes less sensitive

a nurse is caring for a client who had a below-the-knee amputation for gangrene of the right foot. the client report sensations of burning and crushing pain in the toes of the absent right foot. which of the following statement should the nurse make

use a hair dryer on a cool setting to blow air into the cast

a nurse is caring for a client who had a fiberglass cast placed on her left arm several hours ago and now reports itching under the cast. which of the following actions should the nurse plan to take

parietal bones form the larger part of the upper and side

a nurse is caring for a client who has a depressed skull fracture of the bone that makes up larger part of the upper and side wall of the cranium. the fracture is located on which of the following bonea. sphenoid--part of faceb. occipital--back of scullc. parietald. frontal--front of skull

encourage the client to perform dorsiflexion of the affected extremity every 2 hr

a nurse is caring for a client who has a fractured hip and was placed in Buck's traction 4hr ago. which of the following actions should the nurse take

meperidine-residual limb pain

a nurse is caring for a client who has chronic phantom limb pain following an above knee amputation. which of the following medication prescription should the nurse verify with providera. meperidineb. amitriptylinec. gabapentind. propranolol

Buck's traction: is used prior to hip arthroplasty to maintain alignment and prevent muscle spasms prior to surgery

a nurse is caring for a client who has fractured right hip. which of the following types of traction should the nurse expect the client to have prior to hip arthroplasty surgerya. balanced skeletal traction-stabilize fractures of femur/pelvisb. pelvic belt-treat back painc. pelvic sling-stabilize pelvic fracturesd. Buck's traction

fortified milk

a nurse is caring for a client who has osteoporosis and a new prescription for calcium supplements. which of the following foods should the nurse recommend to promote calcium absorptiona. fortified milk--vit Db. ripe bananasc. steamed broccolid. green leafy vegetables

rewrap the residual limb with bandage 3 times per day

a nurse is caring for a client who is 3 days postoperative following a below-the-knee amputation. which of the following actions should the nurse take

shortening of the right leg

a nurse is caring for a client who is 3 days postoperative following a right total hip arthroplasty. while transferring to a chair, the client cries out in pain. the nurse should assess the client for which of the following manifestations of dislocation of the hip prosthesisa. bulging in the area over the surgical incisionb. shortening of the right legc. a sensation of warmth over the surgical incisiond. pallor following the elevation of the right leg

assist the client into a prone position every 4 hr for 20-30min.avoid elevating the limb for 72hrreapply bandage every 4-6hr in a distal to proximal direction

a nurse is caring for a client who is 72 hr postoperative following an above-the-knee amputation. which of the following actions should the nurse take

have the client use a trapeze to pull himself up while ensuring the weight hangs freely

a nurse is caring for a client who is in skeletal traction following a femur fracture. on entering, the nurse finds that the client has slid towards the foot of the bed, and the traction weight is resting on the floor. which of the following actions should the nurse take

logroll the client in bed for care procedures

a nurse is caring for a client who is postoperative following a lumbar disk excision. which of the following interventions should the nurse include in the client's plan of care

ask the client to describe the characteristics of the pain

a nurse is caring for a client who is postoperative following a total knee arthroplasty and has been prescribed a continuous passive motion (CPM) machine and PCA. The client tells the nurse, i am in so much pain, which of the following actions should the nurse take first

hold your arm against the side of your body

a nurse is caring for a client who is postoperative following shoulder surgery. the client has a prescription to keep the affected arm adducted. which of the following instructions should the nurse share with the client

with the leg on the affected side abducted

a nurse is caring for a client who is scheduled to undergo surgery to repair an open hip fracture. in which of the following positions should the nurse plan to place the client postoperatively

monitor the client's vitals every 4 hrsmonitor the client pin sites for looseningcheck the client skin to ensure the jacket is not applying pressure

a nurse is caring for a client who is wearing a halo fixator. which of the following interventions should the nurse implement?

you will have considerably less pain with the traction in place-the traction will help decrease muscle spasms-the weight act as a pulling force to keep your leg and hip still

a nurse is caring for a client with a hip fracture who has Buck's extension traction in place. which of the following pieces of information should the nurse give the client about this type of traction?

a. small body framed. low vitamin D intakee. smoking

a nurse is determining a client's risk of developing osteoporosis. the nurse should identify which of the following as a risk factors for bone loss? a. small body frameb. hypertensionc. African-American ethnicityd. low vitamin D intakee. smoking

osteoarthritis can impair a joint on a single side of the body

a nurse is discussing the difference between rheumatoid arthritis (RA) and osteoarthritis with a newly licensed nurse. which of the following should the nurse include about osteoarthritisnote: rheumatoid arthritis is an autoimmune disease that leads to a decreased erythrocyte sedimentation rate-rheumatoid affects other organ system

your provider might prescribe a central catheter line for long term antibiotic therapy because osteomyelitis is a chronic bone infectionlimit weight bearing

a nurse is discussing the plan of care with a client who has osteomyelitis. of an open wound on his heel. which of the following information should nurse include

celecoxib

a nurse is performing medication reconciliation for a newly admitted client who has rhematoid arthritis. which of the following medications should the nurse identify as the treatment for this conditiona. misoprostolb. dantrolene--for muscle spasm c. celecoxibd. colchicine

place a pillow between the client's legs

a nurse is planning care for a client following a total hip arthroplasty. which of the following interventions should the nurse include in the plana. position the client with her legs adductedb. internally rotate the client's affected hipc. place a pillow between the client's legsd. instruct the client to avoid flexing her hip more than 95-avoid more than 90 degrees to avoid hip dislocation

a special camera will scan the bones in my entire bodyi will have to drink a lot of water to help get the radiation out of my bodyi understand the radiation is harmless, and i dont have to worry about it

a nurse is preparing a client for a bone scan. which of the following statement indicates that the client understands the pre-procedure teaching

i will use my heating pad if i feel any muscle spasms in my back

a nurse is preparing a client for discharge who is postoperative following a conventional lumbar disk excision. which of the following statements indicates that the client understands the nurse instructionsa. i should have no problem climbing stairs when i get homeb. i will wait about 3 weeks before i return to my usual activitiesc. i will use my heating pad if i feel any muscle spasms in my backd. i can go back to driving in about 2 weeks

i will use a Reacher to help me pick up anything i drop on the floorclean with soap and water every dayperform straight leg raise

a nurse is preparing a client who is postoperative following total hip arthroplasty for discharge. which of the following statements indicates that the client understands the instructions

the doctor will be able to see if i have signs of rheumatoid arthritis

a nurse is preparing a client who is scheduled to have an arthroscopy the following day. which of the following statements indicates the pre-procedure teaching.

walking is the preferred mode of exercise to maintain strong bones.

a nurse is preparing a community education program about reducing the risk of osteoporosis. which of the following pieces of information should the nurse include

communited

a nurse is preparing an in-service presentation about the basics of bone injuries. which of the following types of fractures results when a client bone breaks into multiple piecesa. avulsionb. comminuted c. compressiond. spiral

offering the client a diet high in fluid and fiberinspect pin site every 8-12hr

a nurse is preparing to care for a client who is in balanced skeletal traction to stabilize a femur fracture. which of the following actions should the nurse include in the client plan of care

cut the wiring if emesis occur

a nurse is providing discharge instructions for a client who is postoperative following inner maxillary fixation with wiring. which of the following pieces of information should the nurse includea. cut the wiring if emesis occurb. consume 3 meal daily as part of a low protein dietc. swab the mouth with hydrogen peroxide if wiring produces oral irritationd. resume a soft diet in 3 to 5 days--1-4wks

i should not cross my legs at the ankles or kneesinspect the hip incision everyday for redness, warmth

a nurse is providing discharge teaching for a client who had a left total hip arthroplasty. which of the following client statements indicates the teaching was effective

rest frequently after periods of activity

a nurse is providing discharge teaching to a client who has osteoarthritis. which of the following instruction should the nurse includea. rest frequently after periods of activityb. perform your exercise only on days that you feel goodc. perform your exercises after applying cold packs to your jointsd. place a large pillow under your knees when lying down

vitamin D

a nurse is providing nutrition education to a client who has osteomalacia. the nurse should identify that this condition is caused by a deficiency in which of the following nutrients?a. fluorideb. vitamin Ac. vitamin Dd. phosphorus

i will keep my leg elevated for the first dayno aspirin-risk for bleedingice for 24 hrlimit activity

a nurse is providing post-procedural teaching to a client who had a diagnostic knee arthroscopy. which of the following statements indicates that the client understand the nurse instruction

i should wear elastic stockings on both of my legs to prevent venous thromboembolism

a nurse is providing preoperative teaching for a client who is scheduled for total knee arthroplasty. which of the following statements by the client indicates an understanding of the teachinga. i will wear a continuous movement machine on my knee for 24hr a day b. i should avoid taking NSAIDs medications for pain after surgeryc. i should wear elastic stockings on both of my legsd. i will begin exercising my legs the day after surgery--do it immediately

i will have handrails installed in my bathroom-take hot showers-move around-balance activity with rest 1-2 nap

a nurse is providing teaching about disease management to a client who has rheumatoid arthritis. which of the following responses by the client indicates understanding of the teaching?

instruct the client to lie prone while in bed

a nurse is providing teaching for a client following a below-the-knee amputation. which of the following pieces of information should the nurse include in the teaching?a. instruct the client to lie prone while in bedb. ensure the client sleeps on a soft mattressc. pull up the residual limb while in bedd. keep the residual limb exposed to air

aspirin

a nurse is reviewing the medical record of a client who has a prescription for probenecid to treat gout. the nurse should identify that which of the following medications can interacts with probenecida. colchicine b. naproxen c. aspirind. prednisone

history of anorexia nervosa because of inadequate protein intake

a nurse is reviewing the medical record of a female client. which of the following findings should the nurse identify as a risk factor for osteoporosis history of anorexia nervosa because of inadequate protein intake

begin a program of brisk walking

a nurse is talking with an older adult client who has an elevated risk for osteoporosis about strategies for preventing bone loss. which of the following instructions should the nurse providea. begin a program of brisk walkingb. take 800 mg of calcium per day--1200c. drink plenty of sparkling waterd. drink 8 oz of red wine each day

i will lie on my stomach for 30 min a few times a day

a nurse is teaching a client who had an amputation of the left lower leg 3 day ago which of the following statements indicates that the client understands how to care for the incision and his left upper leg

i will call the doctors office if my fingers get colder on the arm with the cast

a nurse is teaching a client who has a cast on his left arm to treat a forearm fracture. which of the following statements indicates that the client understands the teaching.

perform weight-bearing exercise

a nurse is teaching a client who has osteoporosis. which of the following instructions should the nurse include in the teachinga. reduce dietary protein intakeb. apply ice to painful areasc. increase calcium intake to 900 mg per dayd. perform weight-bearing exercise

i should cough and deep-breath every hourrange of motion exercise 3-4 times per dayankle pump exercise 1-2hr

a nurse is teaching a client who is in bed rest about preventing complications. which of the following client statements indicates an understanding of the teaching

apply heat to your joint prior to exercising

a nurse is teaching a client with arthritis who is experiencing joint pain that impairs mobility. which of the following instruction should the nurse includea. engage your joints in resistance exercises b. avoid using assistive devices when walkingc. perform passive exercisesd. apply heat to your joint prior to exercising

extended periods of immobility increase your risk of osteoporosis and prolong use of corticosteroid

a nurse is teaching a group of client at a senior center about the risk factors of osteoporosis. which of the following statements should the nurse include in the teaching

compartment syndrome

involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of musclespressure rises to damage muscles and nerves and results in muscle ischemia from inadequate capillary blood flow (6-12 hrs)

pulmonary embolus

the nurse is caring for a client who has a pelvic fracture. the client report sudden shortness of breath, stabbing chest pain, and feelings of doom. this client is experiencing which of the following complicationsa. pneumoniab. pulmonary embolusc. tension pneumothoraxd. tuberculosis