MedSurg Ch. 41

A patient in the emergency department is being treated for a wrist fracture. The patient asks why a splint is being applied instead of a cast. What is the best response by the nurse?

"A splint is applied when more swelling is expected at the site of injury."

A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction?

Buck's

Which nursing assessment finding would be indicative of compartment syndrome in the client with a cast applied to the left forearm 3 hours earlier?

Capillary refill of left fingers greater than 3 seconds

A client who is undergoing skeletal traction complains of pressure on bony areas. Which action would be most appropriate to provide comfort for the client?

Changing the client's position within prescribed limits.

Which of the following would be inconsistent as a component of self-care activities for the patient with a cast?

Cover the cast with plastic to insulate it

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician?

Crackles in the lung bases

The client displays manifestations of compartment syndrome. The nurse expects the client to be scheduled for:

A fasciotomy

A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client?

Exploring factors related to the client's home environment.

The nurse is very concerned about the potential debilitating complication of peroneal nerve injury. What symptom does the nurse recognize as a result of that complication?

Footdrop

The nurse assesses a patient after total right hip arthroplasty and observes a shortening of the extremity, and the patient complains of severe pain in the right side of the groin. What is the priority action of the nurse?

Notify the physician.

Which of the following orthopedic surgeries is done to correct and align a fracture after surgical dissection and exposure of the fracture?

Open reduction

A variety of complications can occur after a leg amputation. All of the following are possibilities in the immediate postoperative period, except?

Osteomyelitis

Which action by the nurse would be inappropriate for the client following casting?

Protect the cast by covering with a sheet.

A client is brought to the emergency department by a softball team member whostates the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize?

Right shoulder slopes downward and droops inward.

Which of the following is an inaccurate principle of traction?

Skeletal traction is interrupted to turn and reposition the patient.

A patient had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated?

The left leg is internally rotated.

A client is about to have a cast applied to his left arm. The nurse would alert the client to which of the following as the cast is applied?

Sensation of warmth or heat with application

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide?

"Limit hip flexion to 90 degrees."

A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse?

"We will need to monitor the status of the laceration to be sure it does not get infected."

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority?

Assessing the extremity for neurovascular integrity

After undergoing surgery the previous day for a total knee replacement, a client states that he doesn't feel ready to ambulate yet. What should the nurse do?

Discuss the complications that the client's may experience if he doesn't cooperate with the care plan.

The physician is preparing to bivalve the client's cast. Which supplies should the nurse assemble?

Elastic compression bandages

Which type of cast encloses the trunk and a lower extremity?

Hip spica

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Farenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which of the following complications?

Hypovolemic shock

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan?

Increase fiber intake.

The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, "How can I stay like this for weeks? I can't even move!" Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis?

Ineffective Coping related to prolonged immobility

Which of the following statements describes external fixation?

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

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?

Total arthroplasty

A client was playing softball and dislocated four of his fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as?

Closed reduction

A nurse is caring for a client with a cast on his left arm after sustaining a fracture. Which assessment finding is most significant for this client?

Fingers on the left hand are swollen and cool

Which intervention should the nurse implement with the client who has undergone a hip replacement?

Instruct the client to avoid internal rotation of the leg.

Which of the following is a benefit of a continuous passive motion (CPM) device when applied after knee surgery?

It promotes healing by increasing circulation and movement of the knee joint.

Which intervention would the nurse implement with the client in skeletal traction? Select all that apply.

• Ensure the pins or wires are covered with caps. • Position trapeze within the client's reach. • Instruct the client on isometric exercises for immobilized extremity.

A patient with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care? Select all that apply.

• Prepare for cast removal. • Provide support to the injured extremity.

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.)

• "Place pillows between your legs when you lay on your side." • "Avoid bending forward when sitting in a chair." • "Use a raised toilet seat and high-seated chair."

A 12-year-old client fractured her right leg several weeks ago while skiing and is returning to the orthopedist to have her cast removed. What would you expect the physician to prescribe as further treatment?

Physical therapy

Which of the following devices is designed specifically to support and immobilize a body part in a desired position?

Splint

The nurse is caring for a patient with a total hip replacement. How should the nurse allow the patient to turn?

45 degrees onto the unoperated side if the affected hip is kept abducted

Which of the following statements is accurate regarding care of a plaster cast?

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.

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for?

Pulmonary embolism

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fracture tibia. What should the nurse inform the client prior to the cast being removed?

The skin may be covered with a yellowish crust that will shed in a few days. Once the cast is off, the skin appears mottled and may be covered with a yellowish crust composed of accumulated body oil and dead skin. The client usually sheds this residue in a few days. The leg will not look as it did prior to the cast but will regain the same shape and status as the other leg. There should be no bumps underneath the cast. The leg may be weak and stiff for some time after the cast is removed, not stronger.

All of the following are guidelines for avoiding hip dislocation after replacement surgery. Select the answer that is not.

You may flex at the hip to put on clothing such as pants, stockings, socks, or shoes.

Which of the following nursing actions would help prevent deep vein thrombosis in a patient who has had an orthopedic surgery?

Applying antiembolism stockings

A patient arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the patient to describe the pain?

Sharp and piercing