prep u chapter 40

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse? A. "CPM increases range of motion of the joint." B. "CPM strengthens the muscles of the leg." C. "CPM delivers analgesic agents directly into the joint." D. "CPM prevents injury by limiting flexion of the knee."

A. "CPM increases range of motion of the joint."

Which of the following is an inappropriate nursing diagnosis for the client following casting? A. Risk for deficient knowledge: procedure B. Risk for impaired tissue perfusion C. Risk for impaired skin integrity D. Risk for disuse syndrome

A. Risk for deficient knowledge: procedure

Arthrodesis is: A. fusion of a joint (most often the wrist or knee) for stabilization and pain relief. B. total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain. C. replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. D. cutting and removal of a wedge of bone (most often the tibia or femur) to change the bone's alignment, thereby improving function and relieving pain.

A. fusion of a joint (most often the wrist or knee) for stabilization and pain relief.

A client with a right leg fracture is returning to the orthopedist to have the cast removed. During cast removal, it is important for the nurse to assure: A. the client that he or she won't be cut. B. that pedal pulses are present. C. that the leg will be as good as new. D. that the cast cutter blade is new.

A. the client that he or she won't be cut.

Which principle applies to the client in traction? A. Weights are removed routinely. B. Skeletal traction is never interrupted. C. Weights should rest on the bed. D. Knots in the ropes should touch the pulley.

B. Skeletal traction is never interrupted.

Which of the following would the nurse expect a physician to use on a short-term basis for a client with an injured body part that does not require rigid immobilization? A. Skin traction B. Splint C. Cast D. Brace

B. Splint

Which statement is accurate regarding care of a plaster cast? A. The cast will dry in about 12 hours. B. The cast can be dented while it is damp. C. A dry plaster cast is dull and gray. D. The cast must be covered with a blanket to keep it moist during the first 24 hours.

B. The cast can be dented while it is damp.

For which of the following immobility-related complications is the client in traction at risk? Select all that apply. A. Cachexia B. Thromboemboli C. Urinary stasis D. Diarrhea E. Lactose intolerance

B. Thromboemboli C. Urinary stasis

Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure? A. Arthroplasty B. Osteotomy C. Arthrodesis D. Fasciotomy

D. Fasciotomy

hich statement describes external fixation? A. The bone is restored to its normal position by external manipulation. B. The bone is surgically exposed and realigned. C. The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. D. The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

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

The nurse is admitting a client who is to undergo an open reduction with internal fixation for a fractured femur. About which comment by the client should the nurse be most concerned? A. "I was worried I would have an incision and scar." B. "The surgeon is planning to use a metal plate and screws to fix my hip." C. "A joint replacement or bone graft is not necessary." D. "The surgeon can see the bones when putting them in correct position."

A. "I was worried I would have an incision and scar."

A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first? A. "My toes are stiff." B. "My pain is a 3." C. "My toes are pink." D. "My cast is still wet."

A. "My toes are stiff."

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) A. "Place pillows between your legs when you lay on your side." B. "You may cross your legs at the ankles only." C. "Avoid bending forward when sitting in a chair." D. "It is okay to briefly flex the hip to put on your clothes." E. "Use a raised toilet seat and high-seated chair."

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

A client diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse? A. "The joint above the fracture and below the fracture must be immobilized." B. "When a spica cast is ordered, the arm must be immobilized." C. "The method allows for the fastest healing time and the greatest mobility." D. "This allows for the strength in the arm to remain consistent."

A. "The joint above the fracture and below the fracture must be immobilized."

The nurse is caring for a patient with a total hip replacement. How should the nurse allow the patient to turn? A. 45 degrees onto the unoperated side if the affected hip is kept abducted B. From the prone to the supine position only, and the patient must keep the affected hip extended and abducted C. To any comfortable position as long as the affected leg is extended D. To the operative side if the affected hip remains extended

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

Which interventions should a nurse implement as part of initial pain relief for the client with a cast? Select all that apply. A. Apply cold packs B. Apply a new cast C. Administer analgesics D. Elevate the involved part E. Provide passive range of motion

A. Apply cold packs C. Administer analgesics D. Elevate the involved part

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? A. Apply lotions and take warm baths or soaks. B. Scrub the area vigorously to remove the crust. C. Avoid exposure to direct sunlight. D. Consult a skin specialist.

A. Apply lotions and take warm baths or soaks.

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse? A. Assess for complications. B. Reposition the client for comfort. C. Teach relaxation techniques. D. Assess for previous opioid drug use.

A. Assess for complications.

Which nursing assessment finding would be indicative of compartment syndrome in the client with a cast applied to the left forearm 3 hours earlier? A. Capillary refill of left fingers greater than 3 seconds B. Fingers pink and warm and move freely C. Absence of numbness and tingling D. Radial pulses palpable and +2 bilaterally

A. Capillary refill of left fingers greater than 3 seconds

A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do? A. Cut a cast window. B. Remove the cast. C. Apply a fiberglass cast. D. Initiate physical therapy.

A. Cut a cast window.

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? A. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. B. Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. C. Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength. D. Have the patient extend both hands while the nurse compares the volume of both radial pulses.

A. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? A. It promotes healing by increasing circulation and movement of the knee joint. B. It provides active range of motion. C. It prevents infection and controls edema and bleeding. D. t promotes healing by immobilizing the knee joint.

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

A client has undergone an external fixation. Which actions would be the priority for this client? A. Maintaining pin care. B. Monitoring the client's blood pressure. C. Planning the client's diet. D. Monitoring the client's urine output.

A. Maintaining pin care.

The client with a newly applied cast reports severe unrelenting pain. What is the nurse's best response? A. Make the client NPO and notify the health care provider. B. Loosen the edges of the cast and elevate the leg. C. Reposition the extremity for comfort and apply heat. D. Administer a dose of morphine sulfate.

A. Make the client NPO and notify the health care provider.

Which intervention should the nurse implement with the client who has an external fixator? Select all that apply. A. Perform pin care as ordered. B. Turn the clamps by one-half every day. C. Supervise the client during transfers. D. Perform neurovascular assessment. E. Inspect pin sites for signs of infection.

A. Perform pin care as ordered. C. Supervise the client during transfers. D. Perform neurovascular assessment. E. Inspect pin sites for signs of infection.

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? A. Pulmonary embolism B. Urinary tract infection C. Atelectasis D. Hypovolemia

A. Pulmonary embolism

The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is: A. Risk for ineffective therapeutic regimen management B. Situational low self-esteem C. Disturbed body image D. Risk for avascular necrosis of the joint

A. Risk for ineffective therapeutic regimen management

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain? A. Sharp and piercing B. Similar to "muscle cramps" C. Sore and aching D. A dull, deep, boring ache

A. Sharp and piercing

A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied? A. Short leg cast B. Long leg cast C. Walking cast D. Hip spica cast

A. Short leg cast

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? A. Total arthroplasty B. Arthrodesis C. Hemiarthroplasty D. Osteotomy

A. Total arthroplasty

A patient has a cast removed after bone healing takes place. What should the nurse instruct the patient to do after removal? (Select all that apply.) A. Use a razor to shave the dead skin off. B. Control swelling with elastic bandages, as directed. C. Gradually resume activities and exercise. D. Use friction to remove dead surface skin by rubbing the area with a towel. E. Apply an emollient lotion to soften the skin.

B. Control swelling with elastic bandages, as directed. C. Gradually resume activities and exercise. E. Apply an emollient lotion to soften the skin.

A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client? A. Removal of the cast B. Cutting a cast window C. Cutting of a bivalve cast D. Insertion of an external fixator

B. Cutting a cast window

Which intervention would the nurse implement with the client in skeletal traction? Select all that apply. A. Remove foam boot and inspect skin daily. B. Ensure the pins or wires are covered with caps. C. Instruct the client on isometric exercises for immobilized extremity. D. Position trapeze within the client's reach. E. Apply 8-pound weight to the rope.

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

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 Fahrenheit, 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 complication? A. Osteomyelitis B. Hypovolemic shock C. Atelectasis D. Urinary retention

B. Hypovolemic shock

Which intervention should the nurse implement with the client who has undergone a hip replacement? A. Adduct the legs by placing a pillow between the legs. B. Instruct the client to avoid internal rotation of the leg. C. Have the client bend forward to rise from the chair. D. Place the client in high Fowler's position for meals.

B. Instruct the client to avoid internal rotation of the leg.

The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery? A. Bend forward only when seated in a chair B. Never cross the affected leg when seated C. Avoid placing a pillow between the legs when sleeping D. Keep the knees together at all times

B. Never cross the affected leg when seated

Which is not a guideline for avoiding hip dislocation after replacement surgery. A. Keep the knees apart at all times. B. The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. C. Never cross the legs when seated. D. Put a pillow between the legs when sleeping.

B. The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes.

client is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm? A. Abduction and adduction of the shoulder B. Use of isometric exercises C. Repositioning the arm in the cast D. Proper use of a sling

B. Use of isometric exercises

A client with a right leg fracture is returning to the orthopedist to have the cast removed. What would the physician prescribe as further treatment? A. No options are correct. B. physical therapy C. discontinue use of crutches D. cold compresses to leg for swelling

B. physical therapy

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? A. "Monitoring skin integrity is important while the continuous passive motion device is in place." B. "The continuous passive motion device can decrease the development of adhesions." C. "The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." D. "Bleeding is a complication associated with the continuous passive motion device."

C. "The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device.

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? A. "The splint is less expensive than the cast." B. "You will be able to wear the splint longer than you would a cast." C. "We will need to monitor the status of the laceration to be sure it does not get infected." D. "The arm does not require the same immobilization that a leg fracture would."

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

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation? A. Internal rotation B. Adduction C. Abduction D. Flexion

C. Abduction

A group of students are reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast? A. More breathable B. Quicker drying C. Better molding to the client D. Longer-lasting

C. Better molding to the client

After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do? A. Document the client's refusal to ambulate. B. Tell the client that this noncompliance will be reported to the health care provider. C. Discuss the complications that the client may experience if there is lack of cooperation with the care plan. D. Do nothing because the client has the ultimate right to determine the degree of participation.

C. Discuss the complications that the client may experience if there is lack of cooperation with the care plan.

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication? A. Re-fracture of the hip B. Avascular necrosis of the hip C. Dislocation of the hip D. Contracture of the hip

C. Dislocation of the hip

The nurse teaching the client with a cast about home care includes which instruction? A. Cover the cast with plastic or rubber B. Keep the cast below heart level C. Dry a wet fiberglass cast thoroughly to avoid skin problems D. Fix a broken cast by applying tape

C. Dry a wet fiberglass cast thoroughly to avoid skin problems

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure? A. Replacement of one of the articular surfaces of a joint B. Incision and diversion of the muscle fascia C. Excision of damaged joint fibrocartilage D. Replacement of knee with artificial joint

C. Excision of damaged joint fibrocartilage

A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied? A. Walking cast B. Hip spica cast C. Short leg cast D. Long leg cast

C. Short leg cast

Which device is designed specifically to initially support and immobilize a body part in a desired position until swelling subsides? A. Continuous passive motion (CPM) device B. Brace C. Splint D. Trapeze

C. Splint

Which device is designed specifically to support and immobilize a body part in a desired position? A. Brace B. Sling C. Splint D. Traction

C. Splint

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? A. Assess the client's level of consciousness. B. Remove the traction at least every 8 hours. C. Teach the client how to prevent problems caused by immobility. D. Apply the traction straps snugly.

C. Teach the client how to prevent problems caused by immobility.

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? A. Remove the traction at least every 8 hours. B. Apply the traction straps snugly. C. Teach the client how to prevent problems caused by immobility. D. Assess the client's level of consciousness.

C. Teach the client how to prevent problems caused by immobility.

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed? A. The leg will look as it did prior to the cast being applied. B. The leg will look moist and will have small bumps that will go away in a few days. C. The skin may be covered with a yellowish crust that will shed in a few days. D. The leg strength is enforced by the wearing of the cast.

C. The skin may be covered with a yellowish crust that will shed in a few days.

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation? A. Flexion B. Internal rotation C. Adduction D. Abduction

D. Abduction

A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client? A. Administering prescribed analgesics. B. Applying warm compresses. C. Assisting with range-of-motion and isometric exercises. D. Changing the client's position within prescribed limits

D. Changing the client's position within prescribed limits

The nurse is assisting with the application of a cast. What will the nurse expect to be done first? A. Covering the skin with a stockinette. B. Applying strips of the cast material evenly. C. Arranging for an x-ray to check bone alignment. D. Cleaning the skin surface.

D. Cleaning the skin surface.

Which would be contraindicated as a component of self-care activities for the client with a cast? A. Do not attempt to scratch the skin under a cast B. Cushioning rough edges of the cast with tape C. Elevate the casted extremity to heart level frequently D. Cover the cast with plastic to insulate it

D. 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? A. Heart rate of 94 beats/minute B. Client complains of pain in the affected rib area when taking a deep breath C. Blood pressure of 140/90 mm Hg D. Crackles in the lung bases

D. Crackles in the lung bases

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate? A. Call for assistance to hold the client in the required position until the cast has dried. B. Remove the cast immediately, notifying the physician. C. Administer antianxiety and pain medication. D. Explain that the sensation being felt is normal and will not burn the client.

D. Explain that the sensation being felt is normal and will not burn the client.

A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period? A. Neuroma B. Unexplainable burning pain (causalgia) C. Chronic osteomyelitis D. Hematoma

D. Hematoma

Which type of cast encloses the trunk and a lower extremity? A. Body cast B. Short-leg C. Long-leg D. Hip spica

D. Hip spica

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention? A. Keep the legs in abduction. B. Position the client on the affected side. C. Promote elimination with a regular bedpan. D. Keep the cast clean and dry.

D. Keep the cast clean and dry.

A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for? A. Open reduction and internal fixation of the left hip. B. Left hip arthroscopy C. Closed reduction of the left hip. D. Left hip arthroplasty

D. Left hip arthroplasty

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority? A. Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use B. Supporting the traction weights with a chair or table to prevent accidental slippage C. Monitoring the client for skin breakdown D. Maintaining traction continuously to ensure its effectiveness

D. Maintaining traction continuously to ensure its effectiveness

The nurse is caring for a client with an external fixator that requires pin care twice a day. The nurse observes that there is a new purulent drainage around one of the pins. What intervention should the nurse anticipate doing? A. Applying iodine-based solution B. Scrubbing the drainage from around the pin site C. Apply ointment to the pin site. D. Obtaining a culture

D. Obtaining a culture

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? A. Buck's traction B. Internal fixation C. Skeletal traction D. Open reduction

D. Open reduction

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? A. Apply the traction straps snugly. B. Assess the client's level of consciousness. C. Remove the traction at least every 8 hours. D. Teach the client how to prevent problems caused by immobility.

D. Teach the client how to prevent problems caused by immobility.

Which statement describes external fixation? A. The bone is restored to its normal position by external manipulation. B. The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. C. The bone is surgically exposed and realigned. D. The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

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

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? A. Body aligned opposite to line of traction pull B. Ropes freely moving over pulleys C. Pulleys without evidence of the obstruction D. Weights hanging and touching the floor

D. Weights hanging and touching the floor

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period? A. hematoma B. hemorrhage C. infection D. osteomyelitis

D. osteomyelitis

Which is an inaccurate principle of traction? A. The client must be in good alignment in the center of the bed. B. The weights are not removed unless intermittent treatment is prescribed. C. The weights must hang freely. D. Skeletal traction is interrupted to turn and reposition the client.

Skeletal traction is interrupted to turn and reposition the client.

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.) A. Decreased sensory function B. Excruciating pain C. Loss of motion D. Capillary refill less than 3 seconds E. 2+ peripheral pulses in the affected distal pulse

A. Decreased sensory function B. Excruciating pain C. Loss of motion

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? A. Keeping the client from sliding to the foot of the bed B. Assessing the extremity for neurovascular integrity C. Ensuring that the weights hang free at all times D. Keeping the ropes over the center of the pulley

B. Assessing the extremity for neurovascular integrity

Which cleansing solution is the most effective for use in completing pin site care? A. Betadine B. Chlorhexidine C. Hydrogen peroxide D. Alcohol

B. Chlorhexidine

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? A. Joint arthroplasty B. Open reduction C. Total joint arthroplasty D. Arthrodesis

B. Open reduction

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? A. 72 hours B. 2 to 3 weeks C. 24 hours D. 1 week

C. 24 hours

The nurse is caring for a patient postoperatively following orthopedic surgery. The nurse assesses an oxygen saturation of 89%, confusion, and a rash on the upper torso. What does the nurse suspect is occurring with this patient? A. Polyethylene-induced infection B. Pneumonia C. Fat emboli syndrome D. Disseminated intravascular coagulation

C. Fat emboli syndrome

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? A. "I will wear a boot with weights attached." B. "The traction can be removed once a day so I can shower." C. "A belt will go around my pelvis and weights will be attached." D. "Metal pins will go through my skin to the bone."

D. "Metal pins will go through my skin to the bone."

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? A. An open reduction B. A total knee replacement C. A total hip replacement D. A fasciotomy

D. A fasciotomy