13.B & 13.C Fractures/Hip Fractures

The nurse is performing an admission assessment on an older adult male who has a suspected hip fracture. Which​ pre-existing situation might be found in the​ client? (Select all that​ apply.) A. Over age of 80 B. Wheelchair bound C. Bedridden D. Diabetes E. Chronic steroid use

A, B, C ​Rationale: Because of potential complications associated with hip replacement​ surgery, hip replacement is contraindicated for clients with limited mobility prior to the​ fracture, for clients at high risk of infection​ (steroid use,​ immunosuppressed), and for clients who are too ill to undergo any form of anesthesia. If diabetes is well​ controlled, the client would be a surgical candidate. Age is not a contraindication.

Which information should the nurse provide a​ 70-year-old client to prevent falls and hip​ fractures? (Select all that​ apply.) A. Avoiding excessive alcohol use B. Participating in​ weight-bearing exercises C. Having an eye exam every year D. Limiting cigarette smoking E. Taking 500 mg of calcium every day

A, B, C ​Rationale: Yearly eye​ exams, daily​ weight-bearing exercises, and avoiding excessive alcohol use are interventions to help reduce falls and prevent hip fractures. Any amount of cigarette smoking places a client at risk of hip​ fractures; the client needs to refrain from smoking altogether. A postmenopausal woman who is not on estrogen replacement should take​ 1,500 mg of calcium daily.

The nurse notes that a client with a​ 2-day postoperative internal fixation femur fracture is a current​ two-pack-a-day smoker. Which complication should the nurse expect due to the​ client's smoking​ habit? (Select all that​ apply.) A. Delayed bone healing B. Decreased blood circulation to bone C. Higher incidence of infection D. Osteomyelitis E. Increased bone density

A, B, C, D ​Rationale: Evidence-based practice has demonstrated that the multiple toxins found in cigarettes may lead to delayed​ healing, lower bone​ density, and decreased circulation to the bone. This leads to increased nonunion rates and increases in other postsurgical complications.

The nurse is teaching a group of older adults about risk factors related to hip fractures. Which information should the nurse include in the​ presentation? (Select all that​ apply.) A. Tobacco use B. Osteoporosis C. Lack of physical activity D. Calcium deficiency E. Arthritis

A, B, C, D ​Rationale: Risk factors for hip fractures include lack of physical​ activity; deficiency in calcium or vitamin​ D; tobacco and alcohol​ use; and osteoporosis. Arthritis is not considered a risk factor for hip fractures.

A client fell off a ladder and the healthcare provider suspects a fracture of the right wrist. Which manifestation should the nurse anticipate observing in the​ client? (Select all that​ apply.) A. Visible deformity B. Pain C. Cyanosis of nail beds D. Crepitus E. Absence of radial pulse

A, B, D Rationale: The manifestations of a fracture include visible​ deformity, swelling,​ pain, numbness,​ crepitus, hypovolemic​ shock, muscle​ spasms, or ecchymosis. A complication of a​ fracture, compartment​ syndrome, may occur if pressure from edema builds within the​ fascia, leading to decreased blood flow and potential muscle and nerve damage. Neurovascular changes may be noted when this occurs which can include absence of pulse and cyanosis of the nail beds.

A client had a cast applied to a fractured​ limb, and the healthcare provider has ordered frequent neurovascular checks. Which assessment should the nurse​ perform? (Select all that​ apply.) A. Paresthesia B. Color C. Position D. Pain E. Temperature

A, B, D, E Rationale: When conducting a neurovascular​ assessment, the 5 Ps should be evaluated. This includes​ pain, pallor,​ pulse, paresthesia, and paralysis. Position is not part of the neurovascular assessment.

The nurse is assessing a​ client's risk for sustaining a hip fracture. Which information should the nurse obtain when obtaining the health​ history? (Select all that​ apply.) A. History of falls B. Skin integrity C. History of osteoporosis D. Age E. Vital signs

A, C, D ​Rationale: The health history of a client with a hip fracture should include​ age, history of​ falls, and history of osteoporosis. Vital signs and skin integrity are obtained when performing a physical examination.

Which client should the nurse identify to be at a greater risk of fractures while reviewing their health​ records? (Select all that​ apply.) A. The client with bone neoplasms B. The client with hypercalcemia C. The client who is malnourished D. The client with osteoporosis E. The client with leukemia

A, C, D ​Rationale: The primary risk factors associated with bone fractures are​ age, presence of bone​ disease, bone​ cancer, and poor nutrition. Leukemia and hypercalcemia are not risk factors for fractures.

The nurse is teaching an older adult client about preventing hip fractures. Which information should the nurse​ include? (Select all that​ apply.) A. Performing​ weight-bearing exercises daily B. Drinking one glass of red wine every night C. Ensuring throw rugs are placed throughout the home D. Maintaining adequate intake of calcium and vitamin D E. Obtaining a screening to test for osteoporosis

A, D, E ​Rationale: Teaching the client about avoiding falls can be helpful in preventing hip fractures.​ Weight-bearing exercises increase strength and adequate intake of calcium and vitamin D helps bone health. Screening for osteoporosis can lead to early treatment to help diminish the risk of bone fractures. Throw rugs are not recommended because the client can trip or slip on them. There is no recommendation to drink red​ wine; in​ fact, alcohol should be consumed with caution as it can impair balance and increase the risk for a fall.

The nurse is caring for a client following the surgical repair of a hip fracture. Which intervention assists in reducing the risk of a deep vein thrombosis​ (DVT)? (Select all that​ apply.) A. Placing compression stockings on the client B. Turning the client every 2 hours C. Using an incentive spirometer every hour D. Positioning an abduction pillow between the legs E. Administering anticoagulants as prescribed

A, E ​Rationale: To reduce the risk of a​ DVT, administer anticoagulants as prescribed and place compression stockings on the client. Using an incentive spirometer reduces the risk of pneumonia. Turning the client every 2 hours prevents skin breakdown. Positioning an abduction pillow between the legs keeps the surgical hip in alignment.

A​ 4-year-old child is admitted with a radial head​ subluxation, or​ "nursemaid's elbow." Which intervention should be taught to the caregivers to prevent such injury in the​ future? A. Avoiding swinging children by the hands B. Avoiding picking up children from under the arms C. Avoiding sports where swinging of the arms is required D. Not allowing children to play on the jungle gym

A. Avoiding swinging children by the hands Rationale: This injury is one that is common in toddlers and occurs when a caregiver pulls or swings a child by the hand with a quick​ motion, resulting in a separation of the radiocapitellar joint. To prevent this type of​ injury, the caregiver should be taught not to swing or pull the child by the hands or arms. The child should be picked up from under the arms. Swinging the arms during activity such as sports or playing on a jungle gym does not cause this type of​ injury, so this education is not indicated

Which pharmacologic treatment should the nurse expect the healthcare provider to prescribe to a client with osteoporosis to prevent hip​ fractures? A. Bone density enhancers B. Incretin mimetic agents C. Loop diuretics D. Selective serotonin reuptake inhibitors​ (SSRIs)

A. Bone density enhancers Rationale: Bone density enhancers​ (e.g., bisphosphonates) stimulate bone growth and can be administered to clients with osteoporosis to prevent hip fractures. Incretin mimetic​ agents, SSRIs, and loop diuretics are not indicated in the treatment of osteoporosis to prevent hip fractures.

The nurse is providing discharge teaching to the family of an older adult client who was treated for a fracture after a fall. Which recommendation should the nurse include in the​ teaching? A. Start a mild exercise program. B. Use a step stool when possible. C. Remove the rubber mat from tub. D. Always wear socks when ambulating.

A. Start a mild exercise program. Rationale: A mild exercise program may help to improve balance and strength. The client should wear shoes with nonslip soles when ambulating to prevent​ falls; socks may cause the client to slip. Use of a step stool should be avoided. Rubber mats are helpful to prevent slipping in the tub.

The nurse is assigned to care for a client who experienced a recent fall. Which manifestation indicates that the​ client's hip is​ fractured? A. The affected leg is shorter than the other and turned outward B. Bruising noted to the injured hip and leg C. Discomfort when performing range of motion exercises D. Complaints of stiffness when transferring to chair

A. The affected leg is shorter than the other and turned outward ​Rationale: The leg of the injured hip is shorter than the uninjured leg and is sometimes turned outward in clients with hip fracture. These clients complain of severe​ pain, not​ discomfort, when flexing and rotating the hip. Bruising noted to the hip and leg may or may not be related to the fall. Complaints of stiffness may be related to the fall or from lying in bed.

An older adult client sustained a hip fracture secondary to a fall and undergoes an arthroplasty. The client refuses to get out of bed due to pain and fatigue. Which response by the nurse is​ correct? A. ​"Early ambulation promotes healing and reduces​ complications." B. ​"We will give you pain medication after you get up and participate in​ therapy." C. ​"You have to get out of bed today because the healthcare provider ordered​ it." D. ​"It is okay to rest​ today, but you need to participate​ tomorrow."

A. ​"Early ambulation promotes healing and reduces​ complications." Rationale: The nurse should inform the client that getting out of bed the first postoperative day will decrease complications and improve mobility. The nurse would not tell the client it is okay to wait one day. The nurse would not inform the client that they need to get out of bed because the healthcare provider ordered it. This is not therapeutic communication and does not provide information. Pain medication should be administered prior to​ therapy, not after.

The nurse is teaching an older adult client on what they need to do if they are alone and sustain a fall. Which client statement indicates a need for additional​ teaching? A. ​"If I​ fall, I should not move because I can cause further​ injury." B. ​"I should try to keep a cell phone with me at all​ times." C. I should participate in an emergency alert service such as​ Lifeline." D. ​"I should ask a friend or family member to check in​ daily."

A. ​"If I​ fall, I should not move because I can cause further​ injury." ​Rationale: When an older adult lives​ alone, measure should be taken for protection. This may involve subscribing to an emergency alert​ system, keeping a cell phone near them at all​ times, and asking friends and family members to check on them frequently. If the client​ falls, they should turn on their stomach or crawl to a phone to get help. They should also cover up with a blanket to stay warm if available until help arrives.

Which statement from the client regarding cast care requires additional teaching by the​ nurse? A. ​"If the edges become rough and​ irritating, I can remove the rough​ edges." B. ​"I can apply ice to the cast and elevate my arm to prevent​ swelling." C. ​"I can use plastic shields around the cast while showering or​ bathing." D. ​"I should never place objects in the cast to relieve​ itching."

A. ​"If the edges become rough and​ irritating, I can remove the rough​ edges." ​Rationale: The client should be taught to protect the cast with plastic while showering or bathing. No part of the​ cast, including rough​ edges, should be removed at any time. Ice and limb elevation may help reduce​ swelling, and no objects should ever be inserted into the cast for any reason.

The nurse has identified that a client who sustained an open femoral fracture is at risk for infection. Which intervention should be implemented to prevent​ infection? (Select all that​ apply.) A. Assessing temperature during every shift B. Administering prophylactic antibiotics per order C. Assessing the wound for​ size, color, or presence of drainage D. Using sterile technique with dressing changes E. Providing pain medications as indicated

B, C Rationale: Clients who have open fractures are at risk for infection. The nurse would assess the wound for manifestations of​ infection, assess vital​ signs, including temperature at least every 4 hours and​ prn, use aseptic technique to change​ dressings, and administer antibiotics as prescribed. Although the nurse may administer pain​ medications, this is not an intervention that will prevent infection.

Which statement concerning bone fractures is​ correct? (Select all that​ apply.) A. ​"A bone fracture can be the direct result of excess pressure in the fibrous membrane or​ fascia." B. ​"Bone fractures may result from repetitive forces or​ twisting." C. ​"The severity of a bone fracture depends on the force of the action against the bone and bone​ strength." D. ​"Bone fractures do not result from low bone​ density." E. ​"Diseases such as neoplasms do not cause bone​ fractures."

B, C ​Rationale: The severity of a bone fracture depends on the force of the action against the bone and bone strength. Bone fractures may result from repetitive forces like​ running, twisting, or a direct blow to the bone. Low bone density is often a precursor to a fracture. Diseases such as neoplasms​ (bone cancer) or osteoporosis may weaken the bones and result in fractures. It is compartment​ syndrome, not a bone​ fracture, which occurs when excess pressure in the space enclosed by the fascia constricts structures within the​ compartment, reducing circulation to muscles and nerves.

The nurse is explaining the use of a splint for an ulnar fracture. Which information should be​ included? (Select all that​ apply.) A. At greater risk for compartment syndrome B. Allows some movement of the joint C. Easily removed if needed D. Can be adjusted if swelling occurs E. May be used as a temporary measure until a cast can be applied

B, C, D, E ​Rationale: A splint provides less support than a cast does but may be used as a temporary measure before a cast is applied​ (to stabilize bone until swelling has​ subsided) and can easily be adjusted to accommodate swelling and prevent compartment syndrome. Splints do allow some movement of the joint and so may also be used during the reparative phase of healing.

The home care nurse is visiting an older adult client with a new diagnosis of macular degeneration and decreased visual acuity. Which instruction should the nurse provide the caregiver to decrease the​ client's risk of sustaining a fall and a hip​ fracture? (Select all that​ apply.) A. Eliminate alcohol B. Remove throw rugs C. Use​ night-lights D. Increase calcium E. Clear pathways

B, C, E ​Rationale: An older adult client with decreased visual acuity is at high risk for falling.​ Therefore, the nurse would instruct the family to clear the​ pathways, use​ night-lights, and remove throw rugs. Calcium should be increased for postmenopausal women. Excessive alcohol intake should be avoided.

The parish health nurse notices a higher incidence of hip fractures in the church community. Which intervention should the nurse implement to help decrease the​ clients' risk of a hip​ fracture? A. Periodic home care visits B. A walking program C. Obtain assistive devices D. Use of medical alert systems

B. A walking program Rationale: Weight-bearing exercise can decrease an​ individual's risk for hip fractures.​ Therefore, establishing a walking program would benefit the parishioners. Assistive devices would help with gait​ stability, but are not required by every individual. Periodic home care visits can check medication compliance and blood​ pressures, but will not prevent hip fractures. Medical alert systems can signal for help after a fall and fracture have​ occurred, but does not prevent it.

The nurse is preparing to send the client who is​ one-day postoperative from a hip arthroplasty for physical therapy. Which intervention should the nurse perform ​first? A. Apply sequential compression stockings B. Administer analgesics C. Administer a diuretic D. Provide the client lunch

B. Administer analgesics Rationale: The nurse should administer analgesics about​ 30-60 minutes prior to attending physical therapy. This minimizes pain during exercise and allows better movement. The nurse would not administer a diuretic prior to going to therapy because the client would have to urinate frequently. The client can eat​ lunch, but it is not a priority. Sequential stockings can only be used while the client is in bed.

A client who was treated for a long bone fracture suddenly has a respiratory rate of 28​ breaths/ min with an oxygen saturation of​ 86% on room air. The client is confused and restless. Which collaborative intervention is​ appropriate? A. Intubating the client immediately B. Applying oxygen and continuing to assess respiratory status C. Immediately immobilizing the pelvic area D. Administering corticosteroids as ordered

B. Applying oxygen and continuing to assess respiratory status Rationale: This client is showing signs of fat embolism syndrome​ (FES). Priority treatment is to administer oxygen and continue to assess respiratory status to try to prevent intubation. Approximately​ 50% of the clients will have to be intubated​ eventually, but the goal is to prevent this invasive treatment. Corticosteroids and immobilization of the injured area may reduce the risk of FES but will not treat the syndrome once it occurs.

The nurse assesses an older adult woman and determines the client is at high risk for osteoporosis and hip fractures. Based on these​ findings, which test should the nurse request from the healthcare​ provider? A. ​X-rays B. Bone density testing C. Computerized tomography​ (CT) scan D. Magnetic resonance imaging​ (MRI) scan

B. Bone density testing ​Rationale: Postmenopausal women with low calcium intake are at a very high risk of osteoporosis and hip fractures.​ Therefore, the healthcare provider will prescribe bone density testing to determine further treatment.​ X-rays, CT​ scans, and MRIs are used to diagnose hip fractures.

A client with a hip fracture has undergone surgery for insertion of a hip prosthesis. Which activity should the nurse instruct the client to​ avoid? A. Sitting in a reclining chair B. Performing​ weight-bearing exercises daily C. Sitting on a raised commode D. Using an abductor pillow while lying on the side

B. Performing​ weight-bearing exercises daily ​Rationale: Weight-bearing exercises should not be resumed until the healthcare provider or physical therapist instructs the client it is safe to do so. Any activity that causes​ flexion, adduction, or internal rotation should be avoided. Using an abductor​ pillow, sitting in a reclining​ chair, or using a raised commode prevents hip flexion and adduction.

Which statement by the nurse describes a comminuted fracture to the​ client? A. The ends of the broken bones are forced​ together." B. The bone is broken into many​ pieces." C. A fragment of the bone is separated from the rest of the​ bone." D. The bone is breaking through the​ skin."

B. The bone is broken into many​ pieces." ​Rationale: In a comminuted​ fracture, the bone is broken into many pieces. The bone fragments may cause further injury or complications. An open or compound fracture involves bone breaking through the skin. An avulsion fracture involves a fragment of bone being separated from the rest of the bone. In an impacted or buckle​ fracture, the ends of the broken bones are forced together.

The nurse is creating a plan of care for the presurgical care of a client with a hip fracture. Which goal would be appropriate for the diagnosis of Tissue ​Perfusion: Peripheral, Ineffective​? A. The client will maintain core body temperature that is within normal limits. B. The client will maintain a distal pulse in the affected extremity. C. The client will report a lowered pain score after administration of pain medications. D. The​ client's open wound will remain free from signs of infection.

B. The client will maintain a distal pulse in the affected extremity. ​Rationale: Tissue perfusion in the affected extremity would be assessed by performing neurovascular checks that would include the 5​ Ps: pain,​ paresthesia, pallor,​ pulse, and paralysis. Core body temperature and the wound being free of infection would be appropriate for a diagnosis of​ Infection, Risk for. Response to pain medication would be appropriate for a diagnosis of​ Pain, Acute. Maintaining a pulse distal to the injury would be an appropriate goal for a diagnosis of Tissue​ Perfusion: Peripheral, Ineffective.​ (NANDA-I ©​ 2014)

The nurse is discussing open reduction and internal fixation with a client who is considering surgery to correct a bone fracture. Which statement by the nurse is​ correct? A. ​"A metal bar will be placed outside the skin to stabilize the​ bone." B. ​"Internal fixation allows earlier return to full​ function." C. ​"A longer hospital stay will be​ required." D. ​"Internal fixation is performed when soft tissue damage prevents external​ fixation."

B. ​"Internal fixation allows earlier return to full​ function." Rationale: The two main types of surgical repair are external fixation and internal fixation. Internal fixation allows for shorter hospital stays and earlier return to full​ function, as well as fewer instances of nonunion and malunion. External fixation is often performed if soft tissue damage prevents internal fixation. A metal bar is attached to pins and screws in external fixation.

The nurse is caring for an​ 8-year-old child who sustained a hip fracture from a motor vehicle crash. The parents ask if the child will be scheduled for a hip replacement. How should the nurse​ respond? A. ​"We will place the child in traction for a few​ days, then do the hip​ replacement." B. ​"Treatment for hip fractures in children often involves casting for 4 to 6​ weeks." C. ​"A hip replacement will be performed once the child is medically​ stable." D. ​"Hip replacements are not done in children because they need to be revised with​ growth."

B. ​"Treatment for hip fractures in children often involves casting for 4 to 6​ weeks." ​Rationale: Hip fractures in children are usually treated with casting for 4 to 6 weeks or repair surgery rather than hip replacement surgery. Hip replacements begin to fail at 10 years and require revision surgery.

The nurse who is caring for a client who has a fractured pelvis has determined that the client is experiencing acute pain. Which intervention should the nurse​ implement? (Select all that​ apply.) A. Applying a hot pack to the site of the injury B. Maintaining strict bedrest until the bone is fused C. Supporting the extremity above and below the fracture site when moving D. Elevating the affected extremity on a pillow E. Playing the​ client's favorite music

C, D, E ​Rationale: Effective pain management for this client may involve administration of pain​ medication, distraction,​ relaxation, deep​ breathing, ice to reduce​ swelling, and gentle movement while supporting the extremity above and below the fracture site to prevent displacement of bony fragments and nerve damage.

The nurse is providing a seminar about hip fracture treatment in the older adult. Which surgery should be​ included? (Select all that​ apply.) A. Fractional ablation B. Appendectomy C. Arthroplasty D. Hemiarthroplasty E. Open internal fixation

C, D, E ​Rationale: Hemiarthroplasty is a partial hip replacement of the ball or head of the femur. Arthroplasty is a total replacement of the ball and socket or head and acetabulum of the hip joint. Open internal fixation is performed to align the bone when placing hardware. Appendectomy and fractional ablation are not indicated for hip fractures.

Which intervention should the nurse include in the plan of care to prevent infection for a client who is recovering from a hip​ replacement? A. Refrain from moving the hip joint. B. Administer anticoagulants as prescribed. C. Keep the incision clean and dry. D. Remove staples​ 3-5 days after surgery.

C. Keep the incision clean and dry. Rationale: The nurse should keep the incision clean and dry and assess for signs of infection. The client should be encouraged to move the new hip joint to increase mobility. Staples are usually removed​ 10-14 days after surgery. Anticoagulants prevent deep vein​ thromboses, not infection.

A client sustained a radial fracture and a cast was just applied. The client states that there is unrelieved pain and numbness in the fingers on the affected side. Which intervention should be a ​priority? A. Preparing for fasciotomy B. Elevating the extremity C. Performing frequent neurovascular checks D. Notifying the healthcare provider for cast removal

D. Notifying the healthcare provider for cast removal ​Rationale: Compartment syndrome occurs when edema and swelling cause increased pressure in a muscle​ compartment, leading to decreased blood flow and potential muscle and nerve damage. This leads to dilation of the blood​ vessels, causing more edema and increasing pressure in the limb. This is a medical​ emergency; the first step in treatment is to remove the tight cast by notifying the healthcare provider. A fasciotomy is indicated when internal pressure is causing the symptoms but would not be indicated unless the cast removal did not relieve the pressure. Neurovascular checks would be performed​ frequently, but cast removal is the priority. Elevating the extremity is indicated to prevent compartment​ syndrome, not to treat the problem if it occurs. This would actually decrease circulation to the extremity.

The nurse is assessing the neurovascular status of a child who is in a hip spica cast for a hip fracture. Which finding indicates the child has good circulation to the affected​ limb? A. Paralysis B. Pallor C. Paresthesia D. Pain​ 1/10

D. Pain​ 1/10 Rationale: The nurse should assess the neurovascular status of a client in a spica cast. This includes assessing​ color, temperature, and sensation. A pain level of​ 1/10 indicates good circulation.​ Pallor, paralysis, and paresthesia indicate circulatory deficits and need to be reported to the healthcare provider.

A client is recovering from a fractured radius that occurred 7 weeks ago. Which process of bone healing should the nurse anticipate the client to be​ experiencing? A. Bony union phase B. Inflammatory phase C. Remodeling phase D. Reparative phase

D. Reparative phase Rationale: The three stages of fracture healing are​ inflammatory, reparative, and remodeling. In the reparative​ phase, fibrocartilage forms a soft callus that joins the fractured bone. This phase usually lasts about 68 weeks after the fracture occurs. Bone union is a process that occurs and is not a phase of healing.

A client diagnosed with a hip fracture is scheduled for an arthroplasty. Which information should the nurse provide when describing this type of surgery to the​ client? A. Partial replacement of the ball or head of the femur B. Percutaneous pinning or compression hip screws that slide within the barrel of the plate C. Insertion of an intramedullary nail into the marrow canal of the bone via an opening made in the greater trochanter D. Replacement of the ball and socket or head and acetabulum of the hip joint

D. Replacement of the ball and socket or head and acetabulum of the hip joint Rationale: Arthroplasty is a total replacement of the ball and socket or head and acetabulum of the hip joint. Partial hip replacement of the ball or head of the femur is a hemiarthroplasty. Insertion of an intramedullary nail into the marrow canal of the bone via an opening made in the greater trochanter is hardware placed when a client has an extracapsular fracture. Percutaneous pinning or compression hip screws that slide within the barrel of the plate is hardware placed when a client has an intracapsular fracture.

The nurse is teaching a new colleague about traction. Which statement by the new colleague indicates a need for further​ teaching? A. ​"Skin traction may be used to control muscle​ spasms." B. ​"Skin traction is contraindicated in older adults with frail​ skin." C. ​"Skeletal traction may be used in conjunction with skin​ traction." D. ​"Traction weights should rest either on the bed or on the​ floor."

D. ​"Traction weights should rest either on the bed or on the​ floor." ​Rationale: Traction weights should never be placed on the bed or the​ floor, which will cause inadequate force on the bone and may change the alignments of the fracture causing a malunion. Weights should hang unencumbered. Skeletal traction may be used in conjunction with skin traction depending on the severity and location of the injury. Skin traction is contraindicated in older adults with frail skin due to increased risk of skin tearing leading to infection. Skin straction may be used to control muscle spasms.

Which information should the nurse include in discharge teaching for a client who had a hip​ arthroplasty? A. ​"Extend the operative leg​ backward." B. ​"Restrict motion for 2​ weeks." C. ​"Place an abduction pillow between the legs only at​ night." D. ​"Use an elevated toilet​ seat."

D. ​"Use an elevated toilet​ seat." ​Rationale: A client who had a hip arthroplasty should use an elevated toilet seat and shower chair to prevent excess flexion of the hip. It is important for the client to ambulate throughout the day and to not restrict​ motion, including extending the legs backwards. An abduction​ pillow, if​ ordered, should be used when​ sleeping, including during the night and when resting during the day.

The nurse is caring for four clients. Which client should the nurse identify as having the highest risk for sustaining a hip fracture if they sustain a​ fall? A. ​60-year-old man admitted for treatment of pneumonia B. ​50-year-old woman with a history of osteoarthritis C. ​80-year-old man admitted for benign prostatic hypertrophy D. ​70-year-old woman who consumes 800 mg​ calcium/day

D. ​70-year-old woman who consumes 800 mg​ calcium/day ​Rationale: Women who are postmenopausal and not taking estrogen should consume a minimum of 1500 mg of calcium per day to maintain bone health. The​ 70-year-old woman who only consumes 800 mg of calcium per day is at the highest risk for a hip fracture if she falls. The​ 50-year-old woman may not be postmenopausal and is at a lower​ risk, and the men are at a lower risk.