Nurs3115 Musculoskeletal Trauma and Orthopedic Surgery

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

.• B. Abdomen is distended and bowel sounds are absent.

The nurse's discharge teaching for a patient who has had a repair of a fractured mandible will include information about • A. administration of nasogastric tube feedings .• B. how and when to cut the immobilizing wires .• C. the importance of high-fiber foods in the diet. • D. the use of sterile technique for dressing changes.

.• B. how and when to cut the immobilizing wires

The patient is taken to the emergency department with an injury to the left arm. Which intervention should the nurse perform first? A. Assess nail beds for capillary refill time B. Remove the patient's clothing from the arm C. Call radiology for a STAT x-ray of the arm D. Prepare the patient for cast application

A. Assess nail beds for capillary refill time

Which interventions should be included in the discharge teaching for a patient who had a total hip replacement? Select all that apply. A. Discuss the patient's weight-bearing limits B. Request the patient demonstrate use of assistive devices C. Explain importance of increasing activity gradually D. Instruct patient not to take medication prior to ambulating E. Tell the patient to ambulate with open-toed house shoes

A. Discuss the patient's weight-bearing limits B. Request the patient demonstrate use of assistive devices C. Explain importance of increasing activity gradually

The nurse is caring for a patient with a fasciotomy of their right lower leg.Which of the following interventions should the nurse include in the plan of care? A. Perform aseptic dressing changes Q4H B. Draw a WBC daily C. Elevate the extremity D. Perform passive range of motion

B. Draw a WBC daily

The nurse is working on an orthopedic floor. Which patient should the nurse assess first after change-of-shift report? A. The 84 y.o. female with a fractured right femoral neck in Buck's traction B. The 64 y.o. female with a left total knee replacement who has confusion C. The 88 y.o. male post-right total hip replacement with an abduction pillow D. The 50 y.o. postop patient with a continuous passive motion (CPM) device

B. The 64 y.o. female with a left total knee replacement who has confusion

The nurse is preparing discharge instructions for a patient who had a total hip replacement from a hip fracture. Which of the following interventions should the nurse include? A. Do not cross your legs longer than 30 minutes at a time B. Use an elevated toilet seat C. Limb shortening is an expected outcome D. When bathing, take tub baths only

B. Use an elevated toilet seat

Which information will the nurse teach seniors at a community recreation center about ways to prevent fractures? A. Tack down scatter rugs in the home. B. Expect most falls to happen outside the home. C. Buy shoes that provide good support and are comfortable to wear. D. Get instruction in range-of-motion exercises from a physical therapist

C. Buy shoes that provide good support and are comfortable to wear.

The nurse is caring for a patient with a fractured left tibia and fibula. Which data should the nurse report to the health-care provider immediately? A. Localized edema and discoloration developing hours after the injury B. Generalized weakness and increased sensitivity to touch C. Dorsalis pedal pulse cannot be located with a Doppler and increasing pain D. Pain relieved after taking four (4) mg of hydromorphone (Dilaudid)

C. Dorsalis pedal pulse cannot be located with a Doppler and increasing pain

A nurse is caring for a client who has an unrepaired femur fracture of the midshaft. Which of the following techniques should the nurse use when performing an assessment of the client's neurovascular status? A. Measure the circumference of the thigh B. Palpate the femoral pulse C. Monitor the patient's calf for edema D. Instruct the patient to wiggle his toes

D. Instruct the patient to wiggle his toes

A factory line worker has repetitive strain syndrome in the left elbow. The nurse will plan to teach the patient about A. surgical options. B. elbow injections. C. wearing a left wrist splint. D. modifying arm movements.

D. modifying arm movements.

A high school teacher with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for arthroplasty of several joints in the left hand. Which patient statement to the nurse indicates a realistic expectation for the surgery? • A. "This procedure will correct the deformities in my fingers." • B. "I will not have to do as many hand exercises after the surgery." • C. "I will be able to use my fingers with more flexibility to grasp things." • D. "My fingers will appear more normal in size and shape after this surgery."

• C. "I will be able to use my fingers with more flexibility to grasp things."

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

• C. Assess leg pulses and sensation.

A patient who slipped and fell in the shower at home has a proximal left humerus fracture immobilized with a long-arm cast and a sling. Which nursing intervention will be included in the plan of care? • A. Use surgical net dressing to hang the arm from an IV pole. • B. Immobilize the fingers of the left hand with gauze dressings. • C. Assess the left axilla and change absorbent dressings as needed. • D. Assist the patient in passive range of motion (ROM) for the right arm.

• C. Assess the left axilla and change absorbent dressings as needed.

A patient arrived at the emergency department after tripping over a rug and falling at home. Which finding is most important for the nurse to communicate to the health care provider? • A. There is bruising at the shoulder area. • B. The patient reports arm and shoulder pain. • C. The right arm appears shorter than the left .• D. There is decreased shoulder range of motion.

• C. The right arm appears shorter than the left

The nurse instructs the patient with a left BKA to lie on their stomach for atleast 30 minutes a day. The patient asks the nurse, "Why do I need to lie on my stomach?" Which statement is the most appropriate response by the nurse? A. "This position will help your lungs expand better." B. "Lying on your stomach will help prevent contractures." C. "This will help decrease phantom pain." D. "This position will take pressure off your backside."

B. "Lying on your stomach will help prevent contractures."

The post-anesthesia care unit (PACU) nurse is caring for a patient who just had a right BKA. Which intervention should the nurse implement? A. Assess the surgical dressing every 2 hours B. Do not allow the patient to see their stump C. Keep a large tourniquet at the patient's bedside D. Perform passive range-of-motion exercises to the left leg

C. Keep a large tourniquet at the patient's bedside

The nurse is assessing a patient who is scheduled for surgical fixation of a compound fracture of the right ulna. Which finding should the nurse report to the healthcare provider? A. Ecchymosis around the fracture site B. Crepitus at the fracture site C. Paresthesia distal to the fracture site D. Diminished range of motion of the right arm

C. Paresthesia distal to the fracture site

A tennis player has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included? A. "You will not be able to serve a tennis ball again." B. "You will begin pendulum exercises tomorrow." C. "Keep the shoulder immobilizer on for the first 4 day." D. "The surgeon will use the drop-arm test to determine the success of surgery."

B. "You will begin pendulum exercises tomorrow."

The orthopedic trauma nurse is receiving shift report. The nurse understands that which of the following patient assignments is at highest risk of developing a fat embolism? A. A 70-year-old male with bilateral crush injuries to their hands B. A 45-year-old female with a transverse fracture of the right iliac crest C. A 30-year-old male with a compression fracture in their C4-C5 D. A 66-year-old female with a stress fracture to their right distal and middle phalanges

B. A 45-year-old female with a transverse fracture of the right iliac crest

The nurse is caring for a patient with a right BKA. The nurse notes there is a large amount of bright red blood on the patient's residual limb dressing. Which intervention should the nurse implement first? A. Notify the healthcare provider B. Assess the patient's blood pressure and pulse C. Reinforce the dressing with an additional dressing D. Check the patient's last hemoglobin and hematocrit level

B. Assess the patient's blood pressure and pulse

The patient admitted with a diagnosis of a fractured hip who is in Buck's traction is complaining of severe pain. Which intervention should the nurse implement? A. Adjust the patient-controlled analgesic machine for a lower dose B. Ensure the weights of Buck's traction are off the floor and hanging freely C. Raise the head of the bed to 45 degrees and the foot to 15 degrees D. Turn the patient onto the affected leg using pillows to support the other leg

B. Ensure the weights of Buck's traction are off the floor and hanging freely

The nurse is providing discharge teaching to the patient who fractured their right humerus. Which information should the nurse include regarding cast care? A. Keep the fractured arm at heart level B. Use a wire hanger to scratch the inside of the cast C. Use a hair dryer on the cool setting for any itchy areas D. Explain that foul smells are expected occurrences

C. Use a hair dryer on the cool setting for any itchy areas

Which discharge instruction will the emergency department nurse include for a patient with a sprained ankle? A. Keep the ankle loosely wrapped with gauze B. Apply a heating pad to reduce muscle spasms C. Use pillows to elevate the ankle above the heart. D. Gently move the ankle through the range of motion.

C. Use pillows to elevate the ankle above the heart.

The nurse is caring for a patient in a short leg cast with an oblique fracture to their right fibula from a motor vehicle accident. Six hours after cast application, the patient complains of tingling in their right foot. Which action should the nurse take first? A. Call the healthcare provider B. Apply an ice pack to the right leg C. Elevate the right leg D. Assess the temperature of the foot

D. Assess the temperature of the foot

The emergency room nurse is receiving a patient who was in a motor vehicle accident. The patient arrives in the ER with multiple contusions to the face and neck from the air bag deployment. Which intervention is the nurse's priority? A. Obtain an X-Ray of the head and neck B. Initiate IV access C. Obtain a 12-lead EKG D. Stabilize the cervical spine

D. Stabilize the cervical spine

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

• A "Check and clean the pin insertion sites daily."

Which action will the nurse take in order to evaluate the effectiveness ofBuck's traction for a patient who has an intracapsular fracture of the right femur? • A. Assess for hip pain. • B. Assess for contractures. • C. Check peripheral pulses. • D. Monitor for hip dislocation.

• A. Assess for hip pain.

A patient who has had open reduction and internal fixation (ORIF) of left lower leg fractures continues to complain of severe pain in the leg 15 minutes after receiving the prescribed IV morphine. Pulses are faintly palpable and the foot is cool to the touch. Which action should the nurse take next? • A. Notify the health care provider. • B. Assess the incision for redness. • C. Reposition the left leg on pillows. • D. Check the patient's blood pressure.

• A. Notify the health care provider.

After being hospitalized for 3 days with a right femur fracture, a patient suddenly develops shortness of breath and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first? • A. Stay with the patient and offer reassurance. • B. Administer prescribed PRN O2 at 4 L/min. • C. Check the patient's legs for swelling or tenderness .• D. Notify the health care provider about the symptoms.

• B. Administer prescribed PRN O2 at 4 L/min.

Which nursing intervention will be included in the plan of care after a patient with a right femur fracture has a hip spica cast applied? • A. Avoid placing the patient in prone position. • B. Ask the patient about abdominal discomfort. • C. Discuss remaining on bed rest for several weeks. • D. Use the cast support bar to reposition the patient.

• B. Ask the patient about abdominal discomfort.

The day after a 60-yr-old patient has open reduction and internal fixation(ORIF) for an open, displaced tibial fracture, the nurse identifies the priority nursing diagnosis as • A. Activity intolerance related to deconditioning. • B. risk for constipation related to prolonged bed rest. • C. risk for impaired skin integrity related to immobility. • D. Risk for infection related to disruption of skin integrity.

• D. Risk for infection related to disruption of skin integrity.