NURS 309 Quiz #13

A patient with a fractured fibula is receiving skeletal traction and has skeletal pins in place. What would the nurse instruct the unlicensed assistive personnel (UAP) to report immediately? 1. The patient wants to change position in bed 2. There is a small amount of clear fluid at the pin sites 3. The traction weights are resting on the floor 4. The patient reports pain and muscle spasm

The traction weights are resting on the floor

A nurse is caring for a client who has had an open reduction internal fixation of a fractured hip. Which nursing assessment of the affected leg is most important after this surgery? 1. Femoral pulse 2. Toes for mobility 3. Condition of the pain 4. Range of motion of the knee

Toes for mobility

What should the nurse do to promote early and efficient ambulation after a client has a midthigh amputation? 1. Keep the head of the bed elevated 2. Place the residual limb on a pillow 3. Turn the client to the prone position routinely 4. Encourage the client to lie on the unaffected side

Turn the client to the prone position routinely

To reduce a hip fracture, the client is placed in traction before surgery for an open reduction and internal fixation. Because the client keeps slipping down in bed, increased countertraction is ordered. How does the nurse increase the countertraction? 1. Elevate the head of the bed 2. Add more weight to the traction 3. Use a slight Trendelenburg position 4. Tie a chest restraint around the client

Use a slight Trendelenburg position

The nurse is caring for a patient with an open fracture. Which intervention does the nurse perform to prevent infection of the fracture? 1. Use aseptic technique for dressing changes and wound irrigations 2. Culture the wound and an obtain an order for antibiotics 3. Place the patient in contact isolation and wear sterile gloves 4. Place the patient on neutropenic precautions and perform hand hygiene

Use aseptic technique for dressing changes and wound irrigations

A client with a fractured hip is helped from the bed to a chair after surgery. The nurse instructs the client to bear most of the weight on the unaffected leg before sitting in a chair. What should the nurse explain is the benefit of bearing most of the weight on the unaffected leg? 1. Can increase circulation in the lower extremities 2. Will help maintain the strength of the unaffected limb 3. Is the quickest method to getting the client to and form the bed 4. Reduces the amount of help necessary to lift the client from the bed to the chair

Will help maintain the strength of the unaffected limb

Nursing care of a client with a fractured hip should include the assessment of pedal pulses. The nurse should assess for which important characteristics of the pedal pulses? 1. Contractility and rate 2. Color of the skin and rhythm 3. Amplitude and symmetry 4. Local temperature and visible pulsations

Amplitude and symmetry

An older adult patient has a fractured humerus. The health care provider is considering the use of electrical bone stimulation and asks the nurse to obtain a medical history on the patient. Which question does the nurse ask to identify if the patient has a contraindication for this therapy? 1. "Are you taking any medication for seizures" 2. "Do you have a cardiac pacemaker" 3. "Have you ever been treated for a stroke" 4. "Do you have a surgically implanted metallic device"

"Do you have a cardiac pacemaker"

A client is in skin traction while awaiting surgery for repair of a fractured femur. The client reports leg discomfort and asks the nurse to release the traction. Which is the nurse's best initial response? 1. "I can't because the weights are needed to keep the bone aligned" 2. "I will remove half of the weights and notify your health care provider" 3. "I'll get your prescribed pain medication to help relieve your discomfort" 4. "I have to follow the health care provider's directions, and releasing weights is not ordered"

"I can't because the weights are needed to keep the bone aligned"

The nurse is educating a patient who will have external fixation for treatment of a compound tibial fracture. What information does the nurse include in the teaching session? 1. "The device allows for early ambulation" 2. "The device is sterile; there is no danger of infection" 3. "The device is substitute therapy for a cast" 4. "The advantage of the device is rapid bone healing"

"The device allows for early ambulation"

A patient is receiving scheduled and prn opioids for severe pain related to a musculoskeletal injury. The nurse finds that the patient's abdomen is distended and bowel sounds are hypoactive. Because the nurse suspects that the patient is having a medication side effect, which question does the nurse ask the patient? 1. "Are you having nausea and vomiting" 2. "When was your last bowel movement" 3. "Does your abdomen hurt" 4. Are you having diarrhea or loose stools"

"When was your last bowel movement"

An older adult has been admitted with a hip fracture. Approximately 20 hours after injury, the patient develops a sign/symptom that he nurse recognizes as an early indicator of fat embolism syndrome. Which sign/symptom is the patient displaying? 1. Severe respiratory distress 2. Significantly increased pulse rate 3. Change in mental status 4. Petechial rash over the neck

Change in mental status

The home health nurse is reviewing environmental safety of an older patient who was discharged to her own home after surgery for a hip fracture. Which observation indicates a need for additional teaching? 1. Patient's bed has been moved to the ground floor level 2. There are handlebars around the toilet and tup 3. Floors are clean and shiny and covered with throw rugs 4. Patient's walker is close to the patient's bedside

. Floors are clean and shiny ad covered in throw rugs

A patient was put into the traction at 0800 hours. Hourly neurovascular checks were ordered for the first 24 hours and then every 4 hours therafter. At what time can the nursing staff start performing the 4-hour checks? 1. 2000 hours same day 2. 0000 hours next day 3. 0800 hours next day 4. 1200 hours next day

0800 hours next day

For what clinical findings of compromised circulation should the nurse assess in a client with a long leg cast? Select all that apply. 1. Foul odor 2. Swelling of the toes 3. Drainage on the cast 4. Increased temperature 5. Prolonged capillary refill

2. Swelling of the toes 5. Prolonged capillary refill

The nurse is reviewing the laboratory results of a patient who may have fat embolism syndrome. Which abnormal laboratory findings accompany this condition? Select all that apply. 1. Decreased PaO2 level (often below 30 mm Hg) 2. Increased erythrocyte sedimentation rate 3. Decreased serum calcium levels 4. Decreased red blood cell and platelet counts 5. Increased serum level of lipids 6. Increased serum potassium levels

1. Decreased PaO2 level (often below 30 mm Hg) 2. Increased erythrocyte sedimentation rate 3. Decreased serum calcium levels 4. Decreased red blood cell and platelet counts 5. Increased serum level of lipids

The nurse is caring for several patients on an orthopedic trauma unit. Which conditions pose a high risk for development of acute compartment syndrome? Select all that apply. 1. Lower legs caught between the bumpers of two cars 2. Massive infiltration of IV fluid into forearm 3. Bivalve cast on the lower leg 4. Multiple insect bites to lower legs 5. Daily use of oral contraceptives 6. Severe burns to the upper extremities

1. Lower legs caught between the bumpers of two cars 2. Massive infiltration of IV fluid into forearm 4. Multiple insect bites to lower legs 6. Sever burns to the upper extremities

After an open reduction and internal fixation of a fractured hip, what assessment of the client's affected leg should the nurse make? Select all that apply. 1. Skin temperature 2. Mobility of the hip 3. Sensation in the toes 4. Condition of the pins 5. Presence of pedal pulse

1. Skin temperature 3. Sensation in the toes 5. Presence of pedal pulse

A client has a total hip replacement. Which clinical indicators of pulmonary embolism indicate that the plan to prevent postoperative thrombus formation has been ineffective? Select all that apply. 1. Flushing of the face 2. Unilateral chest pain 3. Elevation of temperature 4. Sudden onset of shortness of breath 5. Pain rating increase from 2 to 8 in the hip

1. Unilateral chest pain 4. Sudden onset of shortness of breath

The nurse is caring for several orthopedic patients who are in different types of traction. What should the nurse do to assess the traction equipment? Select all that apply. 1. Inspect all ropes, knots, an pulleys once every 24 hours 2. Inspect ropes and knots for fraying or loosening every 8 to 12 hours 3. Check the amount of weight being used against the prescribed weight 4. Observe the traction equipment for proper functioning 5. Check if the ropes have been changed or cleaned within the past 48 hours 6. Reduce or adjust the weights if the patient is having excessive pain

2. Inspect ropes and knots for fraying or loosening every 8 to 12 hours 3. Check the amount of weight being used against the prescribed weight 4. Observe the traction equipment for proper functioning

After the nurse receives change-of-shift report, which patient should be assessed first? 1. A 42-year-old patient with carpal tunnel syndrome who reports pain 2. A 64-year-old patient with osteoporosis awaiting discharge 3. A 28-year-old patient with a fracture who reports that the cast is tight 4. A 56-year-old patient with a left leg amputation who reports phantom pain

A 28-year-old patient with a fracture who reports that the cast is tight

A patient with a leg cast denies pain; toes are pink, capillary refill is brisk and toes move freely, and the leg is elevated with an ice pack. Six hours later, the patient reports worsening pain unrelieved by medication. The patient's toes are cool, and pulse is difficult to detect. What does the nurse suspect is occurring with this patient? 1. Crush syndrome 2. Fat embolism syndrome 3. Acute compartment syndrome 4. Fasciitis

Acute compartment syndrome

The home health nurse reads in the documentation that the patient has Volkmann's contracture that occurred several years ago. Which assessment is the nurse most likely to perform to assess this condition? 1. Ability to do activities of daily living 2. Presence of distal pulses 3. Ability to climb the stairs 4. Need for pain medication

Ability to do activities of daily living

The nursing student is assisting with the care of a patient with musculoskeletal pain related to soft tissue injury and bone disruption. The student sees that the patient has a prn order for pain medication. What does the student to first to decide when to give the pain medication? 1. Ask the health care provider to give specific parameters 2. Ask the primary nurse or the charge nurse for advice 3. Ask the patient about types of activities that increase the pain 4. Ask the nursing instructor for help interpreting the order

Ask the patient about types of activities that increase the pain

The nurse is assessing a patient for severe pain in the right wrist after falling off a step stool. How does the nurse assess this patient's motor function? 1. Performs passive range of motion for the wrist 2. Asks the patient to move the fingers 3. Has the patient flex and extend the elbow 4. Instructs the patient to rotate the wrist

Asks the patient to move the fingers

A patient in traction reports severe pain from a muscle spasm. What is the nurse's priority action? 1. Assess the patient's body alignment 2. Give the patient a prn pain medication 3. Notify the health care provider 4. Remove some of the traction weights

Assess the patient's body alignment

When should the nurse begin the process of rehabilitation when a client is scheduled for an amputation? 1. Before the surgery 2. During the convalescent phase 3. On discharge form the hospital 4. When it is time for a prosthesis

Before the surgery

The nurse is helping to evaluate several patient's to determine candidacy for the Ilizarov external fixation device. Which patient is the best candidate? 1. Older woman who lives alone with a fracture of nonunion 2. Child with a congenital bone deformity whose mother is a nurse 3. Teenager with an open fracture and bone loss of the left lower leg 4. Middle-aged man with a new comminuted fracture of the dominant forearm

Child with a congenital bone deformity whose mother is a nurse

What should the nurse do to assess the neurovascular status of an extremity casted from the ankle to the thigh? 1. Palpate the femoral artery 2. Assess for a positive Homan sign 3. Compress and release the client's toenails 4. Instruct the client to flex and extend the knee

Compress and release the client's toenails

A client had an above-the-knee amputation of the left leg because of trauma from a motor vehicle collision. The health care provider orders ambulation with crutches until the residual limb is healed and the client can be fitted with a prosthesis. What should be the nurse's first intervention? 1. Demonstrate the swing-through crutch walking gait 2. Determine if the client has ever used crutches before 3. Introduce the client to another client who is using crutches 4. Provide a pamphlet that has information about using crutches

Determine if the client has ever used crutches before

A client has a long leg cast. What instructions should the nurse give the client in preparation of crutch walking? 1. Use the trapeze to strengthen the biceps 2. Keep the affected limb in extension and abduction 3. Sit up straight in a chair to develop the back muscles 4. Do exercises in bed to strengthen the upper extremities

Do exercises in bed to strengthen the upper extremities

The nurse must adjust a pain of crutches to properly fit a patient. Which description illustrates correct crutch adjustment? 1. Axilla rest lightly on the top of the crutch when the crutch is moved forward 2. Patient can easily use the crutch without subjective complaints 3. Elbow is flexed no more than 30 degrees when the palm is on the handle 4. Adult patient is of average height, and the crutches are medium-sized

Elbow is flexed no more than 30 degrees when the palm is on the handle

A nurse is caring for a client in the evening after the client has had a below-the-knee amputation. What action should be implemented by the nurse? 1. Elevate the foot of the bed 2. Assist the client out of bed to a chair 3. Have the client crutch walk in the room 4. Reapply the elastic bandage every two hours

Elevate the foot of the bed

The nurse is supervising a new graduate RN caring for a patient with a fracture of the right ankle who is at risk for complications of immobility. For which action should the supervising nurse intervene? 1. Encouraging the patient to go from a lying to a standing position 2. Administering pain medication before the patient begins exercises 3. Explaining to the patient and family the purpose of the exercise program 4. Reminding the patient about the correct use of crutches

Encouraging the patient to go from a lying to a standing position

A nurse suspects the development of compartment syndrome for a client who has sustained blunt trauma to the forearm. For which early sign of compartment syndrome should the nurse assess the client? 1. Warm skin at site of injury 2. Escalating pain in the fingers 3. Rapid capillary refill in affected hand 4. Bounding radial pulse in the injured arm

Escalating pain in the fingers

What should be included in the nurse's instructions to help a client prepare for walking with crutches? 1. Use of the trapeze to strengthen the biceps muscles 2. Exercises with or without weights to strengthen the muscles of the upper extremities 3. The importance of keeping the affected limb in extension and abduction to prevent contractures 4. Isometric exercises of the hamstring muscles while sitting in a chair until circulatory status is stable

Exercises with or without weights to strengthen the muscles of the upper extremities

A patient is prescribed low-intensity pulsed ultrasound treatments for a very slow-healing fracture of the right lower leg. What information does the nurse give this patient related to the treatment? 1. Test for pregnancy before the therapy, and use birth control until treatment is complete 2. The treatment is experimental, but there are no known adverse effects 3. The device is implanted directly into the fracture site, and there is no external apparatus 4. Expect to dedicate approximately 20 minutes each day for a treatment

Expect to dedicate approximately 20 minutes each day for a treatment

The care plan for a client with a fractured hip includes nursing actions to prevent which type of contractures? 1. Flexion of the hip 2. Abduction of the hip 3. Hyperextension of the hip 4. Internal rotation of the hip

Flexion of the hip

Which crutch gait should the nurse teach the client wearing a prosthesis after a single-leg amputation? 1. Tripod 2. Four-point 3. Three-point 4. Swing-through

Four-point

Which nursing action is contraindicated when caring for a client with a newly applied long leg cast? 1. Elevating the cast on a pillow 2. Drying the cast by using a fan 3. Leaving the cast exposed to air 4. Handling the cast with fingertips

Handling the cast with fingertips

A patient comes to the emergency department after slipping on some chalk in her classroom. She "did not have a hard fall" and was able to walk with assistance of on of her students. What type of fracture is this patient most likely to have? 1. Compression 2. Displaced 3. Impacted 4. Incomplete

Imcomplete

A client is admitted with a fracture of the neck of the femur. In what position should the nurse maintain the client's affected extremity? 1. Internal rotation with flexion of the knee and hip 2. External rotation with flexion of the knee and hip 3. Internal rotation with extension of the knee and hip 4. External rotation with extension of the knee and hip

Internal rotation with extension of the knee and hip

What instructions should the nurse provide when the client is allowed out of bed after an above-the-knee amputation? 1. Keep the hip in extension and alignment 2. Keep the hip raised with the residual limb elevated 3. Lift the shoulder and hip of the affected side when taking a step 4. Use the ordered crutches until the residual limb is completely healed

Keep the hip in extension and alignment

A client has an amputation of a lower limb. What instructions should the nurse give the client to prevent a hip flexion contracture? 1. Turn from side to side every 1 to 2 hours 2. Sit in a chair for 30 minutes three times a day 3. Lie on the abdomen 30 minutes four times daily 4. Perform quadriceps muscle setting exercises twice daily

Lie on the abdomen 30 minutes four times daily

A nurse is caring for a client who developed aseptic necrosis after fracture of the head of the femur. The nurse understands that aseptic necrosis is associated with which factor? 1. Infection at the site of the wound 2. Weight-bearing before the fracture is healed 3. Immobilization after reduction of the fracture 4. Loss of blood supply to the head of the femur

Loss of blood supply to the head of the femur

After an above-the-knee amputation of a leg, a client reports pain in the foot that is no longer there. What should the nurse include about phantom limb pain in a discussion with the client? 1. Tactile illusions associated with severed blood vessels 2. Nerve endings in the limb are still intact and react to stimuli 3. An unconscious phenomenon to aid with grieving over the lost body part 4. Hallucinations secondary to emotional symptoms associated with the distress of amputation

Nerve endings in the limb are still intact and react to stimuli

A client has surgery to repair a fractured right hip. Where should the nurse stand when assisting the client to ambulate? 1. Behind the client 2. In front of the client 3. On the client's left side 4. On the client's right side

On the client's left side

An older patient's family is trying to find an appropriate cane for the patient to use because of chronic pain in the right ankle. The nurse instructs that family to purchase which type of cane? 1. One with top that is parallel to greater trochanter of the femur 2. One that crates about 45 degree of flexion in elbow 3. One that is adequate to safely support the patient's weight 4. One with padding on the handle grip to ensure safety

One with top that is parallel to greater trochanter of the femur

A patient comes into the emergency department after falling off his four-wheeler. Assessment of his lower leg reveals bleeding and bone fragments protruding from the skin. What type of fracture does the patient most likely have? 1. Impacted 2. Open 3. Pathologic 4. Displaced

Open

Which position should to the nurse avoid placing a client who had surgery for a total hip replacement? 1. Supine 2. Lateral 3. Orthopneic 4. Semi-Fowler

Orthopneic

An older patient with a hip fracture has prolonged immobility related to difficulties in performing the prescribed weight-bearing exercises. Based on fracture pathophysiology and the patient's abilities, which condition could the patient develop? 1. Osteomyelitis 2. Internal derangement 3. Neuroma 4. Pulmonary embolism

Pulmonary embolism

A female patient with osteoporosis comes to the emergency department after falling suddenly while opening her car door. She said it felt as though her "leg gave way" and caused her to fall. What type of fracture is this patient most likely to have? 1. Pathologic 2. Colles 3. Impacted 4. Compound

Pathologic

A patient has fracture of the right wrist. What is an early sign that indicates this patient may be having a complication? 1. Patient loses ability to wiggle fingers without pain 2. Fingers are cold and pale; pulses are impalpable 3. Pain is severe and seems out of proportion to injury 4. Patient reports a subjective numbness and tingling

Patient reports a subjective numbness and tingling

Which signs/symptoms represents the priority concepts for musculoskeletal trauma? 1. Patient notes mild shortness of breath and palpitations with minor exertion 2. Patient describes discomfort in knee and hip joints that is worse in the morning 3. Patient reports decreased range of motion and pain in leg that is unrelieved by medication 4. Patient has problems getting adequate calcium and vit D because of lactose intolerance

Patient reports decreased range of motion and pain in leg that is unrelieved by medication

The nurse is reviewing the orders for a patient who was admitted for 24-hour observation of leg fracture. A cast is in place. Which order does the nurse question? 1. Elevate lower leg above the level of the heart 2. Perform neurovascular assessments every 8 hours 3. Apply ice pack for 24 hours 4. Provide regular diet as tolerated

Perform neurovascular assessments every 8 hours

What is the priority concept related to changes that occur during the ischemia-edema cycle? 1. Comfort 2. Mobility 3. Tissue Integrity 4. Perfusion

Perfusion

Which member of the health care team is responsible for teaching the patient about proper us of the cane? 1. Occupational therapist 2. Physical therapist 3. Orthopedic surgeon 4. Home health aide

Physical therapist

A nurse is caring for a client with a below-the-knee amputation. What should the nurse encourage the client to do to prepare the residual limb for a prosthesis? 1. Abduct the residual limb when ambulating 2. Dangle the residual limb off the bed frequently 3. Soak the residual limb in warm water twice a day 4. Press the end of the residual limb against a pillow periodically

Press the end of the residual limb against a pillow periodically

The student nurse is assessing a patient with a probable fractured tibia-fibula. What assessment technique used by the student nurse causes the nursing instructor the intervene? 1. Inspects the fracture site for swelling or deformity 2. Instructs the patient to wiggle the toes 3. Assesses bilateral dorsalis pedis pulses 4. Pushes on the leg to elicit pain response

Pushes on the leg to elicit pain response

A nurse is caring for a client with a fracture of the head of the femur. The health care provider places the client in a Buck extension. What explanation does the nurse give the client for why the traction is being used? 1. Reduces muscle spasms 2. Prevents soft tissue edema 3. Reduces the need for cast application 4. Prevents damage to the surrounding nerves

Reduces muscle spasms

A client with a fractured hip is placed in traction until surgery can be performed. What should the nurse explain is the purpose of the traction? 1. Relieve muscle spasm and pain 2. Prevent contractures from developing 3. Keep the client from turning and moving in bed 4. Maintain the limb in a position of external rotation

Relieve muscle spasm ad pain

What should the nurse do to control edema of the residual limb 1 week after a client has an above-the-knee amputation? 1. Administer the prescribed diuretic 2. Restrict the client's oral fluid intake 3. Rewrap the elastic bandage as necessary 4. Keep the residual limb elevated on a pillow

Rewrap the elastic bandage as necessary

Which clinical indicator should the nurse expect to identify when assessing a client with a fracture of the neck of the femur? 1. Adduction with internal rotation 2. Abduction with external rotation 3. Shortening of the affected extremity with external rotation 4. Lengthening of the affected extremity with internal rotation

Shortening of the affected extremity with external rotation

A nurse is caring for a client who had an open reduction and internal fixation of a femoral neck fracture. The client has an order for ambulation with slight weight-bearing on the affected extremity. During the physical assessment the nurse identifies that the client has kyphosis and strong upper arm strength. What assistive devise does the nurse expect the health care provider to order for this client? 1. Crutches 2. Quad cane 3. Straight cane 4. Standard walker

Standard walker

A client experiences a traumatic amputation of a leg in a motor vehicle accident. Which nursing intervention initially should receive the lowest priority? 1. Teaching residual limb care 2. Monitoring hemoglobin levels 3. Maintaining the compression dressing 4. Using therapeutic interviewing techniques

Teaching residual limb care

Which principle should the nurse consider when assisting a client with crutches to learn the four-point gait? 1. Elbows should be kept in rigid extension 2. Most of the weight should be supported by axillae 3. The client must be able to bear weight on both legs 4. The affected extremity should be kept off the ground

The client must be able to bear weight on both legs

A patient has a fractured femur. Which finding would the nurse instruct the unlicensed assistive personnel (UAP) to report immediately? 1. The patient reports pain 2. The patient appears confused 3. The patient's blood pressure is 136/88 mm Hg 4. The patient voided using the bedpan

The patient appears confused

A client has a total knee replacement, and a continuous passive motion device is being used. The nurse concludes that the teaching was effective when the client states, "The goal of this therapy is to: 1. improve joint flexion." 2. maintain muscle tone." 3. prevent tissue breakdown." 4. avoid formation of a blood clot."

improve joint flexion."