Quiz 13 Nurs 309

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

1. encouraging the patient to go from a lying to a standing position

A 30 year old patient who is hospitalized for repair of a fractured tibia and fibula reports shortness of breath. Which complication related to the injury might the patient be experiencing? a. acute renal failure b. fat embolism c. acute compartment syndrome d. pneumonia

b. fat embolism

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 alter, 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? a. Crush syndrome b. fat embolism syndrome c. acute compartment syndrome d. fasciitis

c. acute compartment syndrome

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 (as-needed) order for pain medication. What does the student do first to decide when to give the pain medication? a. ask the health care provider to give specific parameters b. ask the primary nurse or the charge nurse for advice c. ask the patient about types of activities that increase the pain d. ask the nursing instructor help interpreting the order

c. ask the patient about types of activities that increase the pain

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? a. test for pregnancy before the therapy, and use birth control until treatment is complete b. the treatment is experimental, but there are no known adverse effects c. the device is implanted directly into the fracture site, and there is no external apparatus d. expect to dedicate approximately 20 minutes each day for a treatment

d. expect to dedicate approximately 20 minutes each day for a treatment

What is the priority concept related to changes that occur during the ischemia-edema cycle? a. comfort b. mobility c. tissue integrity d. perfusion

d. perfusion

A nurse is teaching crutch walking to a client who had arthroscopic surgery o the knee. On which part of the body should the nurse instruct the client to place weight? 1. the upper arms 2. axillary region 3. palms of the hands 4. both lower extremities

3. palms of the hands

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 the site of injury 2. Escalating pain in the fingers 3. Rapid capillary refill in affected hand 4. Bounding radial pulse in the injured arm

2. Escalating pain in the fingers

For what clinical findings of compromised circulation should the nurse assess in a client with a long leg cast? SATA 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

A patient has a fracture 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

2. the patient appears confused

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

3. a 28 year old patient with a fracture who reports that the cast is tight

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

3. compress and release the client's toenails

A patient with a fracture 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 muscles spasm

3. the traction weights are resting on the floor

A client is ready to walk with crutches after knee surgery. Which crutch-walking technique will the nurse most likely have to reinforce after the client returns from physical therapy? 1. two point 2. four point 3. three point 4. swing through

3. three 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

4. Handling the cast with fingertips

A client has a long leg cast. What instructions should the nurse give the client in preparation for 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

4. do exercises in bed to strengthen the upper extremities

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? a. "the device allows for early ambulation." b. "the device is sterile; there is no danger of infection." c. "the device is a substitute therapy for a cast." d. "the advantage of the device is rapid bone healing."

a. "the device allows for early ambulation."

The home health nurse reads in the documentation that the patient has Voklmann's contracture that occurred several years ago. Which assessment is the nurse most likely to perform to assess this condition? a. ability to do activities of daily living b. presence of distal pulses c. ability to climb the stairs d. need for pain medication

a. ability to do activities of daily living

A patient in traction reports severe pain from a muscle spasm. What is the nurse's priority action? a. assess the patient's body alignment b. give the patient a prn pain medication c. notify the health care provider d. remove some of the traction weights

a. assess the patient's body alignment

The nurse is caring for patients on an orthopedic unit who are being treated with variety of therapies, including immobilization with bandage, a splint, a cast, specialized orthopedic shoe, and traction. What is the priority nursing concern for all of these patients? a. assessment and prevention of neurovascular dysfunction and compromise b. assessment and management of pain and discomfort c. assessment of abilities to do activities of daily living after discharge d. assessment and intervention for concerns related to disability and immobility

a. assessment and prevention of neurovascular dysfunction and compromise

The nurse is caring for a patient with skeletal pins that have been placed for traction. What does the nurse expect in the first 48 hours? a. clear fluid drainage weeping from the pin insertion site b. some bloody drainage at the site but very minimal c. swelling at the site with tenderness to gentle touch d. dressings around the pin sites to be dry and intact

a. clear fluid drainage weeping from the pin insertion site

The nurse is reviewing the laboratory results of a patient who may have fat embolism syndrome. Which abnormal laboratory findings accompany this condition? SATA a. decreased Pao2 level (often below 60 mm Hg) b. increased erythrocyte sedimentation rate c. decreased serum calcium levels d. decreased red blood cell and platelet counts e. increased serum level of lipids f. increased serum potassium levels

a. decreased Pao2 level (often below 60 mm Hg) b. increased erythrocyte sedimentation rate c. decreased serum calcium levels d. decreased red blood cell and platelet counts e. 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? SATA a. lower legs caught between the bumpers of two cars b. massive infiltration of IV fluid into forearm c. bivalve cast on the lower leg d. multiple insect bites to lower legs e. daily use of oral contraceptives f. severe burns to the upper extremities

a. lower legs caught between the bumpers of two cars b. massive infiltration of IV fluid into forearm d. multiple insect bites to lower legs f. severe burns to the upper extremities

A patient with a long leg cast that was applied in the emergency department is being admitted to the orthopedic unit. Which task is best for the nurse to delegate to unlicensed assistive personnel? a. obtain a fracture pan and use caution to prevent spillage on the cast b. assist the patient to stand and bear weight when the cast is dry c. check flexion.extension and color of the toes d. turn the patient every 4-6 hours to allow the cast to dry

a. obtain a fracture pan and use caution to prevent spillage on the cast

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 the family to purchase which type of cane? a. one with top that parallel to greater trochanter of the femur b. one that creates about 45 degrees of flexion of the elbow c. one that is adequate to safely support the patient's weight d. one with padding on the handle grip to ensure safety

a. one with top that parallel to greater trochanter of the femur

A female patient with osteoporosis comes to the emergency department after falling suddenly while opening her car door. She aid it felt as though her "leg gave way" and caused her to fall. What type of fracture is this patient most likely to have? a. pathologic b. colles' c. impacted d. compound

a. pathologic

The nurse is caring for a patient in Bucks' (skin_ traction. Which task is best to delegate to unlicensed assistive personnel (with supervision)? a. turning and repositioning b. inspecting heels and sacral area c. asking the patient about muscle spasms d. adjusting the weight on the apparatus

a. turning and repositioning

The nurse is caring for patient with an open fracture. Which intervention does the nurse perform to prevent infection of the fracture? a. use aseptic technique for dressing changes and wound irrigations. b. culture the wound and obtain an order for antibiotics c. place the patient in contact isolation and wear sterile gloves d. place the patient on neutropenic precautions and perform hand hygiene

a. use aseptic technique for dressing changes and wound irrigations

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? a. performs passive range of motion for the wrist b. asks the patient to move the fingers c. has the patient flex and extend the elbow d. instructs the patient to rotate the wrist

b. asks the patient to move the fingers

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? a. "are you taking any medication for seizures?" b. "Do you have a cardiac pacemaker?" c. "have you ever been treated for a stroke?" d. Do you have a surgically implanted metallic device?"

b. "Do you have a cardiac pacemaker?"

A patient is informed by the health care provider that a fiberglass cast must be applied to the lower extremity. What does the nurse teach the patient about the procedure before the cast is applied? a. "the stockinette should be changed once a week." b. "the cast material will dry and become rigid in a few minutes." c. "the cast will increase your risk for skin breakdown" d. "The fiberglass is not waterproof, so avoiding getting it wet."

b. "the cast material will dry and become rigid in a few minutes."

A patient is receiving scheduled and prn opioids for severe pain related to a musculoskletal 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 questions does the nurse as the patient? a. "are you having nausea and vomiting?" b. "when was your last bowel movement?" c. "does your abdomen hurt?" d. "are you having diarrhea or loose stool?"

b. "when was your last bowel movement?"

In the emergency care of patient with a fracture, which action does the nurse implement first? a. check the neurovascular status of the area distal to the injury: temperature, color, sensation, movement, and distal pulses. Compare affected and unaffected limbs b. Remove or cut the patent's clothing to inspect the affected area while supporting the injured area above and below the injury c. elevate the affected area on pillows, apply an ice pack that is wrapped to protect the skin, and obtain an oder for pain medication d. immobilize the extremity by splinting; include joints above and below the fracture site. Recheck circulation after splinting

b. Remove or cut the patent's clothing to inspect the affected area while supporting the injured area above and below the injury

In older adults, what potential adverse effect can occur with the use of meperidine? a. hypertension b. angina c. kidney failure d. seizures

d. seizures

The nurse is helping to evaluate several patients to determine candidacy for the Ilizarov external fixation device. Which patient is the best candidate? a. older woman who lives alone with a fracture of nonunion b. child with congenital bone deformity whose mother is a nurse c. teenager with an open fracture and bone loss of the left lower leg d. middle aged man with a new comminuted fracture of the dominant forearm

b. child with a congenital bone deformity whose mother is a nurse

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? SATA a. inspect all ropes, nots, and pulleys once every 24 hours b. inspect ropes and knots for fraying or loosening every 8 to 12 hours c. check the amount of weight being used against the prescribed weight d. observe the traction equipment for proper functioning e. check if the ropes have been changed or cleaned within the past 48 hours d. reduce or adjust the weights if the patient is having excessive pain

b. inspect ropes and knots for fraying or loosening every 8 to 12 hours c. check the amount of weight being used against the prescribed weight d. observe the traction equipment for proper functioning

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 this patient most likely have? a. impacted b. open c. pathologic d. displaced

b. open

The nurse is reviewing the orders for a patient who was admitted for 24 hour observation of a leg fracture. A cast is in place. Which order does the nurse question? a. elevate lower leg above the level of the heart b. perform neurovascular assessments every 8 hours c. apply ice pack for 24 hours d. provide regular diet as tolerated

b. perform neurovascular assessments every 8 hours

Which member of the health care team is responsible for teaching the patient about proper use of the cane? a. occupational therapist b. physical therapist c. orthopedic surgeon d. home health aide

b. physical therapist

The nurse is supervising a nursing student who is caring for a patient with a cast to the lower leg who reports pain that is worsening despite medication, with decreased movement and skin sensation. The nurse would intervene if the student performed which action? a. instructs the patient to move the toes b. places an extra pillow underneath the cast c. checks for dorsalis pedis pulse d. checks agency protocol to see who may cut the cast

b. places an extra pillow underneath the cast

The nurse is providing teaching for a ptaient with a forearm cast. What information does the nurse give to the patient? a. "forearm should be in an anatomical position when resting." b. "use an ice pack for the first 6-8 hours, and cover the pack with a towel." c. "sling should distribute weight over a large area of the shoulders and trunk." d. "limit movement of the fingers or wrist joints to prevent pain."

c. "sling should distribute weight over a large area of the shoulders and trunk."

A patient was put into traction at 0800 hours. Hourly neurovascular checks were ordered for the first 24 hours and then every 4 hours thereafter. At what time can the nursing staff start performing the 4 hour checks? a. 2000 hours same ay b. 0000 hours next day c. 0800 hours next day d. 1200 hours next day

c. 0800 hours next day

The nurse is caring for a patient with a plaster splint applied to the ankle. The patient received oral pain medication at 0900. At 1100, the patient reports that the pain is getting worse, not better. What is the nurse's priority action? a. give the patient IV pain medication b. reposition the extremity on a pillow and place an ice pack c. assess the pulses and skin temperature distal to the splint d. call the health care provider to report the increasing pain

c. assess the pulses and skin temperature distal to the splint

An older adult has been admitted with a hip fracture. Approximately 20 hours after injury, the patient develops a sign/symptom that the nurse recognizes as an early indicator of fat embolism syndrome. Which sign/symptom is the patient displaying? a. severe respiratory distress b. significantly increased pulse rate c. change in mental status d. petechial rash over the neck

c. change in mental status

The nurse must adjust a pair of crutches to properly fit a patient. Which description illustrates correct crutch adjustment? a. axilla rests lightly on the top of the crutch when the crutch is moved forward b. patient can easily use the crutch without subjective complains c. elbow is flexed no more than 30 degrees within the palm is on the handle d. adult patient is of average height, and the crutches are medium sized

c. elbow is flexed no more than 30 degrees when the palm is on the handle

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? a. Patient's bed has been moved to the ground floor level b. there are handlebars around the toilet and tub c. floors are clean and shiny and covered with throw rugs d. a patient's walker is close to the patient's bedside

c. floors are clean and whiny and covered with throw rugs

The older patient has a fracture that has failed to heal. Which fracture complication best describes this situation? a. malunion b. avascular necrosis c. nonunion d. crush syndrome

c. nonunion

Which patient has the greatest risk for developing avascular necrosis? a. "little person" with a congenital bone deformity b. woman with osteoporosis and a colles' fracture c. older adult with a hip fracture d. teenage with dislocated shoulder

c. older adult with a hip fracture

Which signs/symptoms represent the priority concepts for musculoskeletal trauma? a. patient notes mild shortness of breath and palpitations with minor exertion. b. patient describes discomfort in knee and hip joints that is worse in the morning c. patient reports decreased range of motion and pain in leg that is unrelieved by medication d. patient has problems getting adequate calcium and vitamin D because of lactose intolerance

c. patient reports decreased range of motion and pain in leg that is unrelieved by medication

The nurse is assessing an adolescent patient with an injury to the shoulder and upper arm that occurred during wrestling practice. What is the best position for this patient's assessment? a. supine so that the extremity can be elevated b. low fowler's on an exam table for patient comfort c. sitting to observe for shoulder droop d. slow ambulation to observe for natural arm movement

c. sitting to observe for shoulder droop

A patient in a cast reporsts a painful "hot spot" underneath the cast, and the nurse notices an unpleasant odor. Which intervention is the nurse most likely to perform first? a. offer the patient a prn pain medication. b. help the patient with hygiene around the cast c. take the patient's temperature and other vital signs d. call the orthopedic technician to change the cast

c. take the patient's temperature and other vital signs

The nurse is instructing a teenage patient who has tibia-fibula fracture that was treated with internal fixation and a long leg cast. He is anxious to know when the cast will be removed so that he can resume football practice. Which statement by the patient indicates a need for additional teaching? a. "there's a possibility that the cast could be removed in 4 weeks." b. "the plates an screws reduce the length of time I'll be in the cast." c. "the cast could remain in place as long as 6 weeks.: d. "i'll use crutches for 2 weeks, and then the cast will be removed"

d. "i'll use crutches for 2 weeks, and then the cast will be removed"

A patient comes to the emergency department after slipping on some chalk in her classroom. She "did no have a hard fall" and was able to walk with assistance of one of her students. What type of fracture is this patient most likely to have? a. compression b. displaced c. impacted d. incomplete

d. incomplete

A 25 year old patient sustained a crush injury to his right upper extremity and right lower extremity when heavy equipment fell on him. Signs and symptoms of hypovolemia and compartment syndrome are prestnt. Management of care for this patient will focus on preventing which complication? a. acute liver failure b. ischemic heart failure c. respiratory failure d. myoglobinuric renal failure

d. myoblobinuric renal failure

A patient who tripped and fell down several stairs reports hearing a popping sounds and fears that she has broken her ankle. How does the nurse initially assess for fracture in this patient? a. measures the circumference of the distal leg b. gently moves the ankle through full range of motion c. inspects for crepitus and kin color d. observes for deformity or misalignment

d. observes for deformity or misalignment

A patient with a lower extremity injury is being treated with external fixation. Which nursing assessment is of particular concern in the care of a patient with this type of system? a. maintaining a 30 degree flexed position of the knee b. measuring the weights used for counter-traction c. observing the patient's ability to adjust the clickers d. observing the points of entry of the pins and wires

d. observing the points of entry of the pins and wires

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

d. patient reports a subjective numbness and tingling

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? a. osteomyelitis b. internal derangement c. neuroma d. pulmonary embolism

d. pulmonary embolism

The student nurse is assessing a patient with a probable fracture tibia-fibula. What assessment technique used by the student nurse causes the nursing instructor to intervene? a. Inspects the fracture site for swelling or deformity b. instructs the patient to wiggle the toes c. assesses bilateral dorsalis pedis pulses d. pushes on the leg to elicit pain response

d. pushes on the leg to elicit pain response

The unlicensed assistive personnel (UAP) is assisting the orthopedic cast technician to cut a window in a patient's cast. What does the nurse instruct the UAP to do? a. check the distal pulses after the window is cut b. clean up and dispose of all casting debris c. inform the patient that the procedure is painless d. save the cutout cast piece so it can be taped in place

d. save the cutout cast piece so it can be taped in place