Ch42

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A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

"Apply ice packs for the first 24 to 48 hours, then apply heat packs."

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? a) "Apply ice packs for the first 24 to 48 hours, then apply heat packs." b) "Apply heat packs for the first 24 to 48 hours." c) "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours." d) "Apply ice packs for the first 12 to 18 hours."

"Apply ice packs for the first 24 to 48 hours, then apply heat packs." Explanation: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.

A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse?

"Elevating the leg might lead to a flexion contracture."

A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse?

"Elevating the leg might lead to a flexion contracture." Elevating the residual limb on a pillow may lead to a flexion contracture; this could jeopardize the client's ability to use a prosthesis. The client does need to turn to both sides but might still be able to do it with the extremity elevated. Elevating the extremity would not increase the risk for compartment syndrome. The limb should not be elevated on pillows or blankets.

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching?

"I'll make sure to keep my ankle elevated as much as possible." Treatment consists of applying ice or a chemical cold pack to the area to reduce swelling and relieve pain for the first 24 to 48 hours. Elevation of the part and compression with an elastic bandage also may be recommended. After 2 days, when swelling no longer is likely to increase, applying heat reduces pain and relieves local edema by improving circulation. Full use of the injured joint is discouraged temporarily, not necessarily three to four weeks. Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically recommended; narcotic analgesics typically are not prescribed.

A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? Select all that apply.

- "I cannot seem to catch my breath." - "I have a pins-and-needles sensation in my toes." - Dorsiplantar weak and unequal bilaterally - T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90%

A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of his activity limitations when he states that he will need to wear the brace for which length of time?

6 to 8 weeks

A patient is recovering in the hospital following a total hip replacement that was performed 2 days ago. In an effort to prevent the common complications associated with the surgical procedure, the nurse should implement which of the following interventions, as ordered? A Application of sequential compression devices B Intermittent urinary catheterization to prevent urinary retention C Provision of a low-fiber, high-calorie diet D Passive range-of-motion (ROM) exercises with the affected leg

The post-amputation client is seen by the home health nurse. One client outcome included preventing exposure to infection. Which finding would indicate to the nurse that this outcome was met?

Absence of fever

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain? 1Avoid administering too much medication becausethe client is older. 2Give pain medication to the client after providing care. 3Administer prescribed pain medication only when the client requests it. 4Administer prescribed analgesics around-the-clock.

Administer prescribed analgesics around-the-clock.

When is it advisable for the nurse to apply heat to a sprain or a contusion? 1Do not apply at all 2After 2 days 3Only after a week 4Immediately

After 2 days

When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction?

Apply ice to the fracture site.

A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin?

As soon as tolerated, after a reasonable period of immobilization

A nurse is caring for a client who has sustained ligament and a meniscal injury to the knee. Which action would be most appropriate to allow the client to progress without causing further injury?

Assist with a gradual introduction of activity. A gradual introduction of activity assists the client with a knee injury to ambulate without causing any further injury. Using NSAIDs or applying ice during the first 48 hours helps ease the pain and the inflammation. The application of heat at a later stage improves the blood circulation. However, the regular use of NSAIDs, cold packs, or heat does not help the client progress without causing any further injury.

If a dislocation is not treated promptly, tissue death due to anoxia can occur. This would be documented as which of the following? a) Heterotopic ossification b) Osteomyelitis c) Subluxation d) Avascular necrosis (AVN)

Avascular necrosis (AVN) Explanation: If a dislocation is not treated promptly, AVN, tissue death due to anoxia and diminished blood supply, and nerve palsy may occur. Subluxation is a partial dislocation of the articulating surfaces. Heterotopic ossification is the abnormal formation of bone, near bones or in muscle, in response to soft tissue trauma after blunt trauma, fracture, or total joint replacement. Osteomyelitis is an acute or chronic inflammation of the bone caused by infection.

A client has been in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma? A external rotation B immobilization C surgical repair D enhancing complications

The nurse is caring for a patient who sustained an open fracture of the right femur in an automobile accident. What does the nurse understand is the most serious complication of an open fracture? A Muscle atrophy caused by loss of supporting bone structure B Infection C Nerve damage D Necrosis of adjacent soft tissue caused by blood loss

When the client who has experienced trauma to an extremity reports severe burning pain, vasomotor changes, and muscles spasms in the injured extremity, the nurse recognizes that the client is likely demonstrating signs of A heterotrophic ossification. B complex regional pain syndrome. C avascular necrosis of bone. D a reaction to an internal fixation device.

Which nursing diagnosis takes highest priority for a client with a compound fracture? A Imbalanced nutrition: Less than body requirements related to immobility B Risk for infection related to effects of trauma C Impaired physical mobility related to trauma D Activity intolerance related to weight-bearing limitations

Two days after application of a cast to treat a fractured femur, the client reports severe, deep, and constant pain in the leg. What willl the nurse suspect? A Chronic venous insufficiency. B Compartment syndrome. C Phlebitis. D Infection.

B Compartment syndrome refers to the compression of nerves, blood vessels, and muscle within a closed space. This leads to tissue death from lack of oxygenation

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include: A body-wide decrease in bone mass. B inability to perform active movement and pain with passive movement. C inability to perform passive movement and pain with active movement. D a growth in and around the bone tissue.

B With compartment syndrome, the client can't perform active movement, and pain occurs with passive movement. A body-wide decrease in bone mass is seen in osteoporosis. A growth in and around the bone tissue may indicate a bone tumor.

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?

Between 24 and 48 hours

A patient has sustained a long bone fracture. The nurse is preparing a care plan for this patient. Which nursing action should the nurse include in the care plan to enhance fracture healing? A Administer high doses of corticosteroids. B Avoid prolonged immobilization of the fracture fragments. C Monitor color, temperature, and pulses of the affected extremity. D Limit weight-bearing and exercising during the recovery.

C The nurse should include monitoring for sufficient blood supply by assessing the color, temperature, and pulses of the affected extremity as adequate blood supply enhances the healing of a fracture. Factors that inhibit fracture healing include inadequate or lack of immobilization of the fracture fragments and administration of corticosteroids. Weight-bearing exercises are encouraged for patients with long bone fracture

Clawlike deformity of the right hand without ability to extend fingers

The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding? 1Extension of the fingers of the right hand 2Nodules on the knuckles of the third and fourth finger 3Clawlike deformity of the right hand without ability to extend fingers 4Dislocation of the fingers

Clawlike deformity of the right hand without ability to extend fingers.

Two days after application of a cast to treat a fractured femur, the patient tells the orthopedic health care provider that he is experiencing severe, deep, and constant pain in his leg. The nurse suspects a diagnosis of:

Compartment syndrome.

Which assessment findings would cause the nurse to suspect compartment syndrome after casting of the leg?

Complaints of numbness and tingling in toes of affected leg

Which type of fracture is one in which the skin or mucous membranes extends to the fractured bone? 1Incomplete 2 Simple 3 Complete 4Compound

Compound

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention?

Compound A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.

Which of the following type of fracture is associated with osteoporosis?

Compression Compression fractures are caused by compression of vertebrae and are associated frequently with osteoporosis. Stress fractures occur with repeated bone trauma from athletic activities, most frequently involving the tibia and metatarsals. An oblique fracture runs across the bone at a diagonal angle of 45 to 60 degrees. A simple fracture (closed fracture) is one that does not cause a break in the skin.

A client comes to the Emergency Department complaining of localized pain and swelling of his lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely?

Contusion

A client presents to the emergency department with an open fracture. What is the first action the nurse should take?

Cover the exposed bone with sterile dressing.

A client presents to the emergency department with an open fracture. What is the first action the nurse should take? 1Assess the client's vital signs and determine allergies. 2Perform a neurovascular assessment of the affected extremity. 3Cover the exposed bone with sterile dressing. 4Assist the physician with reduction of the fracture.

Cover the exposed bone with sterile dressing.

A client presents to the emergency department with an open fracture. What is the first action the nurse should take? a) Assess the client's vital signs and determine allergies. b) Cover the exposed bone with sterile dressing. c) Perform a neurovascular assessment of the affected extremity. d) Assist the physician with reduction of the fracture.

Cover the exposed bone with sterile dressing. Explanation: The exposed bone should be covered with a sterile dressing to protect the deeper tissues from contamination.

The patient presents to the emergency room with an open fracture of the femur. Which action would the nurse implement to prevent the most serious complication of an open fracture?

Cover the wound with a sterile dressing to prevent infection.

The patient presents to the emergency room with an open fracture of the femur. Which action would the nurse implement to prevent the most serious complication of an open fracture? 1Reduce the fracture to prevent additional tissue damage. 2Immobilize the joint to prevent movement of bone fragments. 3Apply a pressure bandage to decrease tissue damage. 4Cover the wound with a sterile dressing to prevent infection.

Cover the wound with a sterile dressing to prevent infection.

A client presents to the emergency department with an open fracture. What is the first action the nurse should take? A Assist the physician with reduction of the fracture. B Assess the client's vital signs and determine allergies. C Perform a neurovascular assessment of the affected extremity. D Cover the exposed bone with sterile dressing.

A patient with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which of the following is the best response by the nurse? 1"Describe the pain and rate it on the pain scale." 2"Pain medication usually does not help this type of pain." 3"Your left toes have been amputated." 4"The pain is really from the nerves in the upper leg."

Describe the pain and rate it on the pain scale.

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear?

Difficulty lying on affected side

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear?

Difficulty lying on affected side Clients with a rotator cuff tear experience pain with movement and limited mobility of the shoulder and arm. They especially have difficulty with activities that involve stretching their arm above their head. Many clients find that the pain is worse at night and that they are unable to sleep on the affected side.

A client who suffers an injury in a local high school hockey game presents with left shoulder pain. The client cannot move the left arm, and the left shoulder is lower than the right shoulder. The nurse recognizes the client most likely has a: 1Dislocated shoulder 2Dislocated elbow 3Cervical injury 4Clavicle fracture

Dislocated shoulder

A client who suffers an injury in a local high school hockey game presents with left shoulder pain. The client cannot move the left arm, and the left shoulder is lower than the right shoulder. The nurse recognizes the client most likely has a: a) Clavicle fracture b) Dislocated elbow c) Dislocated shoulder d) Cervical injury

Dislocated shoulder Explanation: Clinical manifestations of a dislocated shoulder include pain, lack of motion, feeling of an empty shoulder socket, and uneven posture.

Which of the following disorders results in widespread hemorrhage and microthrombosis with ischemia?

Disseminated intravascular coagulation (DIC) DIC is a systemic disorder that results in widespread hemorrhage and microthrombosis with ischemia. AVN of the bone occurs when the bone loses its blood supply and dies. CRPS is a painful sympathetic nervous system problem. FES occurs when the fat globules released when the bone is fractured occludes the small blood vessels that supply the lungs, brain, kidneys, and other organs.

Colles' fracture occurs in which of the following areas? 1Elbow 2Clavicle 3Humeral shaft 4Distal radius

Distal Radius

A client presents to the emergency department gently holding the left arm, which is slightly swollen and painful to the touch. Based on these findings, the nurse: 1Has the client perform active range of motion 2Elevates the arm and applies an ice pack 3Positions the arm below the level of the heart 4Elevates the arm and applies a heating pad

Elevates the arm and applies an ice pack.

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?

Elevating the stump for the first 24 hours

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan? a) Maintaining the client on complete bed rest b) Elevating the stump for the first 24 hours c) Removing the pressure dressing after the first 8 hours d) Applying heat to the stump as the client desires

Elevating the stump for the first 24 hours Explanation: Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. Bed rest isn't indicated and could predispose the client to complications of immobility. Heat application would be inappropriate because it promotes vasodilation, which may cause hemorrhage and increase pain. The initial pressure dressing usually remains in place for 48 to 72 hours after surgery.

A 16-year-old female is brought to the clinic by her mother who is concerned about her daughter's complaints of pain in her arm. The client is a member of her high school crew team and practices for 2 ½ hours every day after school. Which of the following would the nurse suspect? 1Epicondylitis 2Tendonitis 3Ganglion 4Carpal tunnel syndrome

Epicondylitis

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?

Fat embolism Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the injury. It occurs when fat droplets released at the fracture site enter the circulation, become lodged in pulmonary capillaries, and break down into fatty acids. Because these acids are toxic to the lung parenchyma, capillary endothelium, and surfactant, the client may develop pulmonary hypertension. Signs and symptoms of fat embolism include an altered mental status, fever, tachypnea, tachycardia, hypoxemia, and petechiae. Compartment syndrome and infection may complicate any fracture and aren't specific to a pelvis fracture. Volkmann's ischemic contracture is a potential complication of a hand or forearm fracture.

The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a patient who has sustained a fracture. The nurse suspects which complication? 1Compartment syndrome 2Reflex sympathetic dystrophy syndrome 3Hypovolemic shock 4Fat embolism syndrome

Fat embolism syndrome

The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the: 1Trochanteric region. 2Femoral neck. 3Condylar area. 4Shaft of the femur.

Femoral Neck

Which term refers to a break in the continuity of a bone?

Fracture

Which factor inhibits fracture healing?

History of diabetes

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?

Impacted

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture? 1Compression 2Comminuted 3 Impacted 4Greenstick

Impacted

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?

Impacted An impacted fracture is one in which a bone fragment is driven into another bone fragment. A comminuted fracture is one in which the bone has splintered into several fragments. A compression fracture is one in which bone has been compressed. A greenstick fracture is one in which one side of the bone is broken, and the other side is bent.

Which type of fracture involves a break through only part of the cross-section of the bone?

Incomplete An incomplete fracture involves a break through only part of the cross-section of the bone. A comminuted fracture is one that produces several bone fragments. An open fracture is one in which the skin or mucous membrane wound extends to the fractured bone. An oblique fracture runs across the bone at a diagonal angle of 45 to 60 degrees.

A patient suffered an open fracture to the left femur during a horse-riding accident. For which of the following complications is this patient at highest risk? 1Complex regional pain syndrome 2Infection 3Malunion 4Depression

Infection

The nurse is caring for a patient who sustained an open fracture of the right femur in an automobile accident. What does the nurse understand is the most serious complication of an open fracture?

Infection In an open fracture, there is a risk for osteomyelitis, tetanus, and gas gangrene. The objectives of management are to prevent infection of the wound, soft tissue, and bone and to promote healing of bone and soft tissue.

A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? 1Performing passive range-of-motion (ROM) exercises on the client's legs once each shift 2Turning the client from side to side every 2 hours 3Maintaining the client in semi-Fowler's position 4Keeping a pillow between the client's legs at all times

Keeping a pillow between the client's legs at all times

A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?

Keeping a pillow between the client's legs at all times After hip pinning, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period, because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After hip pinning, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.

Which of the following is an inaccurate clinical manifestation of a fracture? 1Lengthening 2Pain 3Deformity 4Crepitus

Lengthening

Which nursing intervention is appropriate for minimizing muscle spasms in the client with a hip fracture?

Maintain Buck's traction.

A patient who was in a motor vehicle crash is diagnosed with a stable T7 spinal fracture with no neurologic deficits. Which of the following nursing interventions should the nurse implement? 1Withhold opioid pain medication to prevent ileus. 2Maintain NPO status (nothing by mouth) for surgical repair. 3Maintain bed rest with head of bed at 20 degrees. 4Sit patient upright in a padded chair for meals.

Maintain bed rest with heads of bed at 20 degrees.

A fracture is termed pathologic when the fracture 1Results in a pulling away of a fragment of bone by a ligament or tendon and its attachment. 2Involves damage to the skin or mucous membranes. 3Occurs through an area of diseased bone. 4Presents as one side of the bone being broken and the other side being bent.

Occurs through an area of diseased bone

A nurse is caring for a client with an intracapsular hip fracture. Identify the area where this client's fracture occurred.

Place X on the ball of the bone

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

Prevent internal rotation of the affected leg.

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? 1Use measures other than turning to prevent pressure ulcers. 2Keep the hip flexed by placing pillows under the client's knee. 3Keep the affected leg in a position of adduction. 4Prevent internal rotation of the affected leg.

Prevent internal rotation of the affected leg.

A client with a traumatic amputation of the right lower leg is refusing to look at the leg. Which action by the nurse is most appropriate?

Provide feedback on the client's strengths and available resources.

Which intervention should the nurse implement when caring for the client who complains of phantom limb pain two months after amputation?

Reassure the client that phantom pain is common.

Which intervention should the nurse implement when caring for the client who complains of phantom limb pain two months after amputation?

Reassure the client that phantom pain is common. The nurse acknowledges the client's complaints of pain.

Which nursing intervention is essential in caring for a client with compartment syndrome?

Removing all external sources of pressure, such as clothing and jewelry

A male client, an ace professional tennis player, sprains his right ankle during a tennis match. The client is immediately rushed to the nurse who provides him with first-aid care. Which of the following would the nurse immediately provide?

Rest, ice, compression, and elevation A method for remembering the treatment for strains, contusions, and sprains is the mnemonic RICE, which refers to rest, ice, compression, and elevation. Sometimes, the letter S is added to the end to refer to stabilization. Nonsteroidal anti-inflammatory drugs may be prescribed to ease the discomfort but exercise is not advisable because the full use of the injured joint is discouraged temporarily.

A client is admitted to the hospital for a fracture of the right femur. Which clinical manifestation supports the diagnosis?

Right leg shorter than left A fractured lower extremity is often shorter than the unaffected one.

Which nursing diagnosis takes highest priority for a client with a compound fracture?

Risk for infection related to effects of trauma

A 19-year-old patient presents to the emergency room with an injury to her left ankle that occurred during a high school basketball game. She complains of limited motion and pain on walking, which increased over the last 2 hours. The nurse knows that her diagnosis is most likely which of the following?

Second-degree sprain A sprain is the result of an injury to ligaments that is caused by a twisting motion. A second-degree sprain is an incomplete tear of the ligament that results in painful weight bearing. A third-degree sprain involves a complete ligament tear with loss of weight-bearing function.

A client sustains an injury to the ligaments surrounding a joint. The nurse identifies this as which of the following? a) Fracture b) Strain c) Sprain d) Contusion

Sprain Explanation: A sprain is an injury to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A contusion is a soft tissue injury resulting from a blow or blunt trauma. A fracture is a break in the continuity of a bone.

A 45-year-old softball player arrives at the emergency department following his injury while sliding into a base during a game. After his examination and radiographs, the physician diagnoses muscle strain and prescribes appropriate treatment. What does the physician mean with the term "strain"? 1Stretched or pulled beyond its capacity 2Subluxation of a joint 3Injuries to ligaments surrounding a joint 4Injury resulting from a blow or blunt trauma

Stretched or pulled beyond its capacity

An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as?

Subluxation A partial dislocation is referred to as a subluxation. A Volkmann's contracture is a claw like deformity that results from compartment syndrome or obstructed arterial blood flow to the forearm and hand. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space and affects nerve innervation, leading to subsequent palsy. A sprain is injury to the ligaments surrounding the joint.

Which laboratory study is most relevant to treating a client who has sustained a pelvic fracture?

Type and crossmatch Because of the rich blood supply to the pelvis, fractures to this area can result in significant blood loss. Type and crossmatch is a priority laboratory test in preparing for fluid replacement. Urine isn't commonly analyzed for myoglobin with this injury unless the mechanism was a crush injury; even then, urinalysis isn't as high a priority as type and crossmatch. Urinalysis and serum ethanol, although part of a trauma workup, aren't relevant to treatment of a pelvic fracture.

Which of the following may occur if a client experiences compartment syndrome in an upper extremity?

Volkmann's contracture

Which of the following may occur if a client experiences compartment syndrome in an upper extremity? a) Subluxation b) Callus c) Volkmann's contracture d) Whiplash injury

Volkmann's contracture Explanation: If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a clawlike deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation.

There are a variety of problems that can become complications after a fracture. Which is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head?

avascular necrosis Avascular necrosis is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head.

A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose?

contusion

Which of the following is a term used to describe a soft tissue injury produced by a blunt force? 1Strain 2Sprain 3Hematoma 4Contusion

contusion

An x-ray demonstrates a fracture in which the fragments of bone are driven inward. This type of fracture is referred to as

depressed. Depressed skull fractures occur as a result of blunt trauma. A compound fracture is one in which damage also involves the skin or mucous membranes. A comminuted fracture is one in which the bone has splintered into several pieces. An impacted fracture is one in which a bone fragment is driven into another bone fragment.

A client who has fallen and injured a hip cannot place weight on the leg and is in significant pain. After radiographs indicate intact but malpositioned bones, what would the physician diagnose?

dislocation In joint dislocation, radiographic films show intact yet malpositioned bones. Arthrography or arthroscopy may reveal damage to other structures in the joint capsule. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. Sprains are injuries to the ligaments surrounding a joint. A fracture is a break in the continuity of a bone.

The type of fracture described as having one side of the bone broken and the other side bent would be:

greenstick.

The type of fracture described as having one side of the bone broken and the other side bent would be:

greenstick. A greenstick fracture is the type of fracture described as having one side of the bone broken and the other side bent. An oblique fracture occurs at an angle across the bone. A spiral fracture is a fracture that twists around the shaft of the bone. A transverse fracture is a fracture that is straight across the bone.

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include:

inability to perform active movement and pain with passive movement.

A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would the physician to perform?

joint manipulation and immobilization The physician manipulates the joint or reduces the displaced parts until they return to normal position, then immobilizes the joint with an elastic bandage, cast, or splint for several weeks.

A fracture is considered pathologic when it

occurs through an area of diseased bone.

A fracture is considered pathologic when it

occurs through an area of diseased bone. Pathologic fractures can occur without the trauma of a fall. An avulsion fracture results in a fragment of bone being pulled away by a ligament or tendon and its attachment. A greenstick fracture presents as one side of the bone being broken and the other side being bent. A compound fracture involves damage to the skin or mucous membranes.

A client has a history of dislocations of the same joint. The nurse understands that this is most likely due to an insufficient deposit of collagen during the healing process, leading to:

reduced tensile strength. A possible complication of dislocation during the healing process involves an insufficient deposit of collagen during the repair stage. The end result is that the ligaments may have reduced tensile strength and future instability, leading to recurrent dislocations of the same joint. An insufficient deposit of collagen does not lead to a loss of function necessarily, allergic reaction, or a complete lack of mobility.

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? 1"Apply heat packs for the first 24 to 48 hours." 2"Apply ice packs for the first 24 to 48 hours, then apply heat packs." 3"Apply ice packs for the first 12 to 18 hours." 4"Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours."

"Apply ice packs for the first 24 to 48 hours, then apply heat packs."

A client who has suffered a compound fracture is preparing for discharge to home. During the teaching session, the client asks why he needs antibiotics for a broken bone. Which response by the nurse is most appropriate?

"Antibiotic therapy has been prescribed as a precaution because your bone was exposed to the environment at the time of your injury." The nurse should tell the client that antibiotics are prescribed as a preventive measure for a client with a compound fracture because such fractures expose the bone to the environment and possible infection. Telling the client to discuss his medications with the physician at his follow-up appointment doesn't address the client's questions or immediate needs. The client needs this medication regardless of his body temperature. Antibiotics don't help a bone fracture to heal.

A nurse is caring for a patient who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.)

- Encouraging the patient to care for the residual limb - Allowing the expression of grief - Introducing the patient to local amputee support groups.

A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications? Select all that apply.

- Pneumonia - Skin breakdown - Sepsis - Delirium

The nurse is caring for a patient after arthroscopic surgery for a rotator cuff tear. The nurse informs the patient that full activity can usually resume after what period of time?

6 to 12 months The course of rehabilitation following repair of a rotator cuff tear is lengthy (i.e., 6 to 12 months); functionality after rehabilitation depends on the patient's dedication to the rehabilitation regimen (NAON, 2007).

d. Fat emboli

8. A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes the patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse understand is likely occurring with this patient? a. Spontaneous pneumothorax b. Cardiac tamponade c. Pneumonia d. Fat emboli

The post-amputation client is seen by the home health nurse. One client outcome included preventing exposure to infection. Which finding would indicate to the nurse that this outcome was met? 1Increased participation in self-care 2Decreased need for pain medication 3Absence of fever 4Decreased activity tolerance

Absence of fever

When is it advisable for the nurse to apply heat to a sprain or a contusion?

After 2 days It is advisable to apply heat on a sprain or a contusion 2 days after a sprain or a contusion has occurred. This is because after 2 days swelling is not likely to increase and as a result heat application reduces pain and relieves local edema by improving circulation. Delaying the application of heat prolongs the pain and increased the risk of local edema.

A client presents at an ambulatory clinic with complaints of pain and aching in the lower left leg. After examining the client, a physician determines the client has experienced a strain related to the client's exercise regimen. The treatment plan includes analgesics, rest, and cold and heat therapies. Which guideline should be included in the care plan?

After 24 hours, apply heat for periods of 15 to 30 minutes. The injury should be managed with cold therapy for the first 24 hours, followed by heat therapy for periods of 15 to 30 minutes. Cold applications should be intermittent to avoid temperature-related injuries to the skin. Physical activities should be restricted for 2 to 5 days depending on the severity of the injury.

When reviewing the history of a female client with a ganglion cyst, which factor would the nurse identify as most likely contributing to the client's current condition? 1Recurrent dislocations 2Employment as a cashier 3Age below 50 years 4Participation as a softball pitcher

Age below 50 years

A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin?

As soon as tolerated, after a reasonable period of immobilization Many impacted fractures of the surgical neck of the humerus are not displaced and do not require reduction. The arm is supported and immobilized by a sling and swathe that secure the supported arm to the trunk (Fig. 43-10). Limitation of motion and stiffness of the shoulder occur with disuse. Therefore, pendulum exercises begin as soon as tolerated by the patient. In pendulum or circumduction exercises, the physical therapist instructs the patient to lean forward and allow the affected arm to hang in abduction and rotate. These fractures require approximately 4 to 10 weeks to heal, and the patient should avoid vigorous arm activity for an additional 4 weeks. Residual stiffness, aching, and some limitation of ROM may persist for 6 months or longer (NAON, 2007).

There are a variety of problems that can become complications after a fracture. Which of the following is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head? 1Avascular necrosis 2Shock 3Pulmonary embolism 4Fat embolism

Avascular necrosis

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain? A Acute compartment syndrome B Heterotopic ossification C Rotator cuff tears D Epicondylitis

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?

Comminuted

Two days after application of a cast to treat a fractured femur, the patient tells the orthopedic heath care provider that he is experiencing severe, deep, and constant pain in his leg. The nurse suspects a diagnosis of: 1Chronic venous insufficiency. 2Phlebitis. 3Infection. 4Compartment syndrome.

Compartment syndrome

Which are clinical manifestations of a fracture?

Crepitus

Which of the following is a term used to describe a soft tissue injury produced by a blunt force? A Hematoma B Strain C Sprain D Contusion

D A contusion is a soft tissue injury produced by blunt force, such as a blow, kick, or fall, that results in bleeding into soft tissues (ecchymosis, or bruising). A hematoma develops when the bleeding is sufficient to form an appreciable solid swelling. A strain, or a "pulled muscle," is an injury to a musculotendinous unit caused by overuse, overstretching, or excessive stress. A sprain is an injury to the ligaments and supporting muscle fibers that surround a joint often caused by a trauma, wrenching or twisting motion.

patient asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse? 1"Elevating the leg might lead to a flexion contracture." 2"You need to turn yourself side to side. If your leg is on a pillow, you would not be able to do that." 3"I am sorry. We ran out of pillows. I can elevate it on a few blankets." 4"Elevating the extremity may increase your chances of compartment syndrome."

Elevating the leg might lead to a flexion contracture.

Which general nursing measure is used for a client with a fracture reduction?

Encourage participation in ADLs

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture?

Encourage participation in ADLs

A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes the patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse understand is likely occurring with this patient? 1Spontaneous pneumothorax 2Pneumonia 3Cardiac tamponade 4Fat emboli

Fat emboli

Fat embolism

Which of the following terms refers to a break in the continuity of a bone? 1Fracture 2Malunion 3Subluxation 4Dislocation

Fracture

Which term refers to a break in the continuity of a bone?

Fracture A fracture is a break in the continuity of the bone. A malunion occurs when a fractured bone heals in a misaligned position. Dislocation is a separation of joint surfaces. A subluxation is a partial separation or dislocation of joint surfaces.

A client is brought in by ambulance to the emergency department after being involved in a motorcycle accident. The client has an open fracture on his tibia. The wound is highly contaminated and there is extensive soft- tissue damage. How would this client's fracture likely be graded?

Grade III

Which term refers to a fracture in which one side of a bone is broken and the other side is bent?

Greenstick

Pelvic fractures have a high mortality rate. The nurse knows to be conscientious in assessing for the two most serious complications. What are those complications? 1Paresthesia and ischemia 2Paralytic ileus and a lacerated urethra 3Hemorrhage and shock 4Thrombophlebitis and infection

Hemorrhage and shock

Pelvic fractures have a high mortality rate. The nurse knows to be conscientious in assessing for the two most serious complications. What are those complications?

Hemorrhage and shock Bleeding occurs because of blood vessel damage from fracture fragments due to laceration of veins and arteries and possibly a torn iliac artery.

Which of the following is a factor that inhibits fracture healing? 1Immobilization of the fracture 2Patient age of 35 3Increased vitamin D and calcium in the diet 4History of diabetes

History of diabetes

Which type of fracture occurs when a bone fragment is driven into another bone fragment?

Impacted An impacted fracture is one in which a bone fragment is driven into another bone fragment. An oblique fracture occurs at an angle across the bone. A spiral fracture is one that twists around the shaft of the bone. A transverse fracture is one that is straight across the bone shaft.

A client has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing his ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have contributed to this complication?

Inadequate immobilization

A 39-year-old softball player has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would you expect the physician to perform? 1Ice and immobilization 2Joint manipulation and immobilization 3Heat and immobilization 4Analgesia and immobilization

Joint manipulation and immobilization

A nurse is preparing to discharge a client from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage what action?

Keep an elastic compression bandage on the ankle.

A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? a) Keeping a pillow between the client's legs at all times b) Maintaining the client in semi-Fowler's position c) Turning the client from side to side every 2 hours d) Performing passive range-of-motion (ROM) exercises on the client's legs once each shift

Keeping a pillow between the client's legs at all times Explanation: After hip pinning, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After hip pinning, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.

Which factor inhibits fracture healing?

Local malignancy

Which is a hallmark sign of compartment syndrome?

Pain

A client was fitted with an arm cast after fracturing her humerus. Twelve hours after the application of the cast, the client tells the nurse that her arm hurts. Analgesics do not relieve the pain. What would be the most appropriate nursing action?

Prepare the client for opening or bivalving of the cast.

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

Prevent internal rotation of the affected leg. The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint. Postoperative total hip replacement clients may be turned onto the unaffected side. The hip may be flexed slightly, but it shouldn't exceed 90 degrees. Maintenance of flexion isn't necessary.

Which nursing intervention is essential in caring for a client with compartment syndrome?

Removing all external sources of pressure, such as clothing and jewelry Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity.

Which nursing intervention is essential in caring for a client with compartment syndrome? a) Wrapping the affected extremity with a compression dressing to help decrease the swelling b) Starting an I.V. line in the affected extremity in anticipation of venogram studies c) Keeping the affected extremity below the level of the heart d) Removing all external sources of pressure, such as clothing and jewelry

Removing all external sources of pressure, such as clothing and jewelry Explanation: Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity.

Subluxation

An elite high school football player has been diagnosed with a shoulder dislocation. The client has been treated and is eager to resume his role on his team, stating that he is not experiencing pain. What should the nurse emphasize during health education?

The importance of adhering to the prescribed treatment and rehabilitation regimen

A school nurse is assessing a student who was kicked in the shin during a soccer game. The area of the injury has become swollen and discolored. The triage nurse should organize care for a

contusion.

Which is not one of the general nursing measures employed when caring for the client with a fracture?

cranial nerve assessment

joint manipulation and immobilization

A nurse is caring for a construction worker who fell from the second story of a building site and fractured the femoral neck. Which nursing diagnosis is a priority for the client? Select all that apply. 1Risk for infection 2Urinary incontinence 3Disturbed body image 4Risk for injury 5Impaired physical mobility

risk for infection risk for injury impaired physical mobility

A client has been diagnosed with a muscle strain. What does the physician mean with the term "strain"?

stretched or pulled beyond its capacity

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse?

"Describe the pain and rate it on the pain scale." The nurse should recognize phantom pain as real and complete a pain assessment as if the limb were attached. The client's pain should be address and treated appropriately. By telling the client that the toes have been amputated or the pain is really from the nerves in the upper leg, the nurse is negating the client's pain. Opioid pain medication can be effective with phantom pain.

Which discharge instruction should a nurse give a client who's had surgery to repair a hip fracture? a) "Don't flex your hip more than 60 degrees, don't cross your legs, and have someone help you put your shoes on." b) "Don't flex your hip more than 120 degrees, don't cross your legs, and have someone help you put your shoes on." c) "Don't flex your hip more than 90 degrees, don't cross your legs, and have someone help you put your shoes on." d) "Don't flex your hip more than 30 degrees,

"Don't flex your hip more than 90 degrees, don't cross your legs, and have someone help you put your shoes on." Explanation: Falls in the home cause most injuries among the elderly. Elderly clients should take measures to decrease the clutter that can contribute to falls, such as removing objects such as throw rugs from the floor. Elderly clients should also install grab bars in the shower and next to the toilet. The threat of fire makes burglar bars on every window impractical.

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

"I don't know if I'll be able to get off that low toilet seat at home by myself." The client requires additional teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Teaching the client to avoid crossing the legs also reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees.

A nurse is caring for a patient who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.)

- Encouraging the patient to care for the residual limb - Allowing the expression of grief - Introducing the patient to local amputee support groups. The nurse creates an accepting and supportive atmosphere in which the patient and family are encouraged to express and share their feelings and work through the grief process. The support from family and friends promotes the patient's acceptance of the loss. The nurse helps the patient deal with immediate needs and become oriented to realistic rehabilitation goals and future independent functioning. Mental health and support group referrals may be appropriate (McFarland et al., 2010). Amputation affects the patient's ability to provide adequate self-care. The patient is encouraged to be an active participant in self-care.

Which client(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply.

- The client with elevated pressure within the muscles - The client with hemorrhage in the site of injury - The client with a plaster cast applied immediately after injury Compartment syndrome occurs in cases of fracture when the normal pressure of a compartment is altered by the force of the injury itself, by development of edema, or by hemorrhaging at the site of the injury, which increases the contents of the compartment, or from outside pressure caused by constriction from a dressing or cast. A client with elevated muscle pressure is at risk for compartment syndrome. The application of a plaster cast immediately after the injury places the client at risk for compartment syndrome because the cast will not allow for edema and therefore will compress the tissue. Clavicle fractures are not a risk factor for compartment syndrome because of the location of the fracture. Ice will assist in decreasing edema and may help prevent compartment syndrome.

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply.

- skin breakdown - wound infection - pneumonia

How long does it take for the bone to regain its former structural strength after a break?

1 year

A 14-year-old patient is treated in the emergency room for an acute knee sprain sustained during a soccer game. The nurse reviews discharge instructions with the patient's mother. The instructions cover pain management and swelling reduction for the acute inflammatory stage which lasts:

24 to 48 hours.

A 77-year-old man is recovering in the hospital after a recent femoral fracture and has rung his call light. The nurse has entered the room to find the patient in distress, clutching his chest while struggling to say, "I can't breathe." The nurse should take prompt action based on the knowledge that this patient may be experiencing what complication of lower extremity fractures? A Thromboembolism B Acute respiratory distress syndrome (ARDS) C Ischemic stroke D Unstable angina

A Venous thromboemboli, including deep vein thrombosis (DVT) and pulmonary emboli (PE), are associated with reduced skeletal muscle contractions and bed rest. Patients with fractures of the lower extremities and pelvis are at high risk for venous thromboemboli. The most frequent signs are sudden onset shortness of breath, restlessness, increased respiratory rate, tachycardia, chest pain, and low-grade temperature. Angina, ARDS and stroke are not common complications of skeletal fractures.

Which of the following is one of the most common causes of death in patients diagnosed with fat emboli syndrome? 1ARDS 2MI 3Stroke 4PE

ARDS

The post-amputation client is seen by the home health nurse. One client outcome included preventing exposure to infection. Which finding would indicate to the nurse that this outcome was met? a) Decreased need for pain medication b) Absence of fever c) Decreased activity tolerance d) Increased participation in self- care

Absence of fever Explanation: Fever would be an indication of infection.

Emergency medical technicians transport a client to the emergency department. They tell the nurse, "He fell from a two-story building. He has a large contusion on his left chest and a hematoma in the left parietal area. He has a compound fracture of his left femur and he's comatose. We intubated him and he's maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag." Which intervention by the nurse has the highest priority?

Assessing the left leg In this scenario, airway and breathing have been established, so the nurse's priority should be circulation. With a compound fracture of the femur, there is a high risk of profuse bleeding; therefore, the nurse should assess the left leg. Neurologic assessment of the pupils and LOC are secondary concerns to airway, breathing, and circulation. The nurse doesn't have enough data to warrant putting the client in Trendelenburg's position.

A client has presented to the emergency department with an injury to the wrist. The client is diagnosed with a third-degree strain. Why would the health care provider prescribe an x-ray of the wrist?

Avulsion fractures are associated with third-degree strains.

A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall? A Impacted fracture B Pathologic fracture C Compound fracture D Transverse fracture

B A pathologic fracture is a fracture that occurs through an area of diseased bone and can occur without trauma or a fall. An impacted fracture is a fracture in which a bone fragment is driven into another bone fragment. A transverse fracture is a fracture straight across the bone. A compound fracture is a fracture in which damage also involves the skin or mucous membranes.

Between 24 and 48 hours

When is it advisable for the nurse to apply heat to a sprain or a contusion? A Only after a week B Do not apply at all C After 2 days D Immediately

C It is advisable to apply heat on a sprain or a contusion 2 days after a sprain or a contusion has occurred. This is because after 2 days swelling is not likely to increase and as a result heat application reduces pain and relieves local edema by improving circulation. Delaying the application of heat prolongs the pain and increased the risk of local edema

Clawlike deformity of the right hand without ability to extend fingers A Volkmann's contracture is a claw like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. The client is unable to extend the fingers and complains of unrelenting pain, particularly if attempting to stretch the hand. Nodule on the knuckles and dislocation are not indicative of Volkmann's contracture.

Which assessment findings would the nurse expect to find in the postoperative client experiencing fat embolism syndrome?

Column B Fat embolism syndrome is characterized by fever, tachycardia, tachypnea, and hypoxia. Arterial blood gas findings include a partial pressure of oxygen (PaO2) less than 60 mm Hg, with early respiratory alkalosis and later respiratory acidosis.

Compartment syndrome. Compartment syndrome refers to the compression of nerves, blood vessels, and muscle within a closed space. This leads to tissue death from lack of oxygenation.

A client comes to the emergency department complaining of localized pain and swelling of his lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely?

Contusion The client's description of blunt trauma by a baseball bat and localized pain in conjunction with swelling and ecchymosis would most likely suggest a contusion. A fracture would be manifested by pain, loss of function, deformity, swelling, and spasm. A sprain would be manifested by pain and swelling; ecchymosis may appear later. A strain is characterized by inflammation, local tenderness, and muscle spasms.

A client presents to the emergency department with an open fracture. What is the first action the nurse should take?

Cover the exposed bone with sterile dressing. The exposed bone should be covered with a sterile dressing to protect the deeper tissues from contamination.

General nursing measures employed when caring for the client with fracture include all of the following, except? 1Assisting with ADLs 2Providing comfort measures 3Administering analgesics 4Cranial nerve assessment

Cranial nerve assessment

Susan Albert has fractured her femur and is being seen in the emergency department. As you are assessing the area, you notice there is a grating sound that you suspect is bone ends moving over one another. What would this be called? 1Crepitus 2Deformity 3False motion 4Spasm

Crepitus

Which are clinical manifestations of a fracture?

Crepitus Clinical manifestations of a fracture include crepitus, deformity, pain, shortening, and loss of function. Lengthening is not a clinical manifestation of fracture.

A client with a traumatic amputation of the right lower leg is refusing to look at the leg. Which action by the nurse is most appropriate? A. Encourage the client to perform range-of-motion (ROM) exercises to the right leg. B Provide wound care without discussing the amputation. C Request a referral to occupational therapy. D Provide feedback on the client's strengths and available resources.

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear? A Increased ability to stretch arm over the head B Pain worse in the morning C Minimal pain with movement D Difficulty lying on affected side

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching? A "I'll get the prescription filled for the narcotic pain reliever." B "I need to stay off my ankle for at least the next 3 to 4 weeks." C "I'll start with ice for the first couple of hours and then apply heat." D "I'll make sure to keep my ankle elevated as much as possible."

D Treatment consists of applying ice or a chemical cold pack to the area to reduce swelling and relieve pain for the first 24 to 48 hours. Elevation of the part and compression with an elastic bandage also may be recommended. After 2 days, when swelling no longer is likely to increase, applying heat reduces pain and relieves local edema by improving circulation.

hich of the following would lead a nurse to suspect that a client has a rotator cuff tear? 1Ability to stretch arm over the head 2Minimal pain with movement 3Pain worse in the morning 4Difficulty lying on affected side

Difficulty lying on affected side.

Which of the following disorders results in widespread hemorrhage and microthrombosis with ischemia? 1Complex regional pain syndrome (CRPS) 2Disseminated intravascular coagulation (DIC) 3Avascular necrosis (AVN) 4Fat embolism syndrome (FES)

Disseminated intravascular coagulation (DIC)

Colles fracture occurs in which area?

Distal radius A Colles fracture is a fracture of the distal radius (wrist). It is usually the result of a fall on an open, dorsiflexed hand.

The nurses instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client? 1Do not flex the hip more than 120 degrees. 2Do not flex the hip more than 90 degrees. 3Do not flex the hip more than 30 degrees. 4Do not flex the hip more than 60 degrees.

Do not flex the hip more than 90 degrees.

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan? 1Elevating the stump for the first 24 hours 2Removing the pressure dressing after the first 8 hours 3Maintaining the client on complete bed rest 4Applying heat to the stump as the client desires

Elevating the stump for the first 24 hours

A client with a right below-the-knee amputation is being transferred from the postanesthesia care unit to a medical-surgical unit. What is the highest priority nursing intervention by the receiving nurse?

Ensure that a large tourniquet is in the room. The client with an amputation is at risk for hemorrhage. A tourniquet should be placed in plain sight for use if the client hemorrhages. Documenting the receiving report is important but is not the highest priority. The nurse may delegate to unlicensed assistive personnel (UAP) the job of gathering more pillows for positioning, but this is not the highest priority. The nurse will need to review the physician's orders for pain medication, but again, this is not the highest priority, because any hemorrhaging by the client needs to be addressed first.

The nurse recognizes that proper positioning of an amputated lower extremity for the prevention of contractures is: 1Flexion 2Extension 3Abduction 4External rotation

Extension

A client with a fracture develops compartment syndrome that requires surgical intervention. The nurse would most likely prepare the client for which of the following? 1Joint replacement 2Amputation 3Bone graft 4Fasciotomy

Fasciotomy

A client with a fracture develops compartment syndrome that requires surgical intervention. The nurse would most likely prepare the client for which of the following? a) Amputation b) Joint replacement c) Bone graft d) Fasciotomy

Fasciotomy Explanation: Surgical treatment of compartment syndrome is achieved with a fasciotomy, a surgical incision of the fascia and separation of the muscle to relieve pressure and restore tissue perfusion. Bone graft, joint replacement or amputation may be done for a client who experiences avascular necrosis.

A nurse is performing a shift assessment on an elderly client who is recovering after surgery for a hip fracture. The client reports chest pain, has an increased heart rate, and increased respiratory rate. The nurse further notes that the client is febrile and hypoxic, coughing, and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this client is likely demonstrating symptoms of what complication?

Fat embolism syndrome

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing:

Fat embolism syndrome

The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication?

Fat embolism syndrome Cerebral disturbances in the client with fat embolism syndrome include subtle personality changes, restlessness, irritability, and confusion. The client with compartment syndrome reports deep, throbbing, unrelenting pain. The client with hypovolemic shock would have a decreased blood pressure and increased pulse rate. Clinical manifestations of reflex sympathetic dystrophy syndrome include severe, burning pain; local edema; hyperesthesia; muscle spasms; and vasomotor skin changes.

A classic indicator of edema and alveolar hemorrhage associated with FES is: 1Hyperventilation. 2Crackles and wheezes. 3Tachycardia. 4Tachypnea.

Hyperventilation

When evaluating for hypovolemic shock, the nurse should be aware of which of the following clinical manifestations?

Hypotension

The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury? 1Hypovolemic 2Cardiogenic 3Neurogenic 4Septicemic

Hypovolemic

A 78-year-old client is in the emergency department following involvement in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of her upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma? 1Enhancing complications 2Surgical repair 3External rotation 4Immobilization

Immobilization

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?

A patient suffered an open fracture to the left femur during a horse-riding accident. For which of the following complications is this patient at highest risk? 1Infection 2Depression 3Malunion 4Complex regional pain syndrome

Infection

Joint manipulation and immobilization

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in his cast care? 1 "A foul smell from the cast is normal." 2"Cover the cast with a blanket until the cast dries." 3"Use a knitting needle to scratch itches inside the cast." 4"Keep your right leg elevated above heart level."

Keep your right leg elevated about heart level.

The nurse should include which intervention in the postoperative care plan? a) Keeping a pillow between the client's legs at all times b) Turning the client from side to side every 2 hours c) Maintaining the client in semi-Fowler's position d) Performing passive range-of-motion (ROM) exercises on the client's legs once each shift

Which nursing intervention is appropriate for minimizing muscle spasms in the client with a hip fracture?

Maintain Buck's traction. Buck's traction decreases pain, muscle spasm, and external rotation by immobilizing the hip fracture.

A client who was in a motor vehicle crash is diagnosed with a stable T7 spinal fracture with no neurologic deficits. Which nursing intervention should the nurse implement?

Maintain bed rest with the head of the bed at 20 degrees. The client should maintain limited bed rest with the head of the bed lower than 30 degrees. If the client's pain is not controlled with a lower form of pain medication, then an opioid may be used to treat the pain. The nurse should monitor for an ileus. Stable spinal fractures are treated conservatively and not with surgical repair. The client should avoid sitting until the pain eases.

One side of the bone is broken and the other side is bent.

Which is a hallmark sign of compartment syndrome?

Pain A hallmark sign of compartment syndrome is pain that occurs or intensifies with passive range of motion.

Which of the following is a hallmark sign of compartment syndrome? 1Pain 2Motor weakness 3Weeping skin surfaces 4Edema

Pain.

A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall?

Pathologic fracture A pathologic fracture is a fracture that occurs through an area of diseased bone and can occur without trauma or a fall. An impacted fracture is a fracture in which a bone fragment is driven into another bone fragment. A transverse fracture is a fracture straight across the bone. A compound fracture is a fracture in which damage also involves the skin or mucous membranes.

Elderly clients who fall are most at risk for which injuries? 1Wrist fractures 2Cervical spine fractures 3Humerus fractures 4Pelvic fractures

Pelvic fractures

Elderly clients who fall are most at risk for which injuries? a) Cervical spine fractures b) Pelvic fractures c) Wrist fractures d) Humerus fractures

Pelvic fractures Explanation: Elderly clients who fall are most at risk for pelvic and lower extremity fractures. These injuries are devastating because they can seriously alter an elderly client's lifestyle and reduce functional independence. Wrist fractures usually occur with falls on an outstretched hand or from a direct blow. Such fractures are commonly found in young men. Humerus fractures and cervical spine fractures aren't age-specific.

When joint manipulation is unsuccessful for a client, he is taken to surgery for surgical repair of his hip injury. He is brought to the ICU where you practice nursing for postoperative recovery. After surgery, the nurse implements measures to prevent complications. Select all of the following which are complications that the nurse seeks to prevent. 1Pneumonia 2Skin breakdown 3Diarrhea 4Wound infection

Pneumonia Skin breakdown Wound infection

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? a) Prevent internal rotation of the affected leg. b) Keep the hip flexed by placing pillows under the client's knee. c) Use measures other than turning to prevent pressure ulcers. d) Keep the affected leg in a position of adduction.

Prevent internal rotation of the affected leg. Explanation: The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint. Postoperative total hip replacement clients may be turned onto the unaffected side. The hip may be flexed slightly, but it shouldn't exceed 90 degrees. Maintenance of flexion isn't necessary.

A client who has had an amputation is being cared for by a multidisciplinary rehabilitation team. What is the primary goal of this multidisciplinary team?

Promote the client's highest possible level of function

A patient with a traumatic amputation of the right lower leg is refusing to look at the leg. Which of the following actions by the nurse is most appropriate? 1Request a referral to occupational therapy. 2Provide wound care without discussing the amputation. 3Encourage the patient to perform range-of-motion (ROM) exercises to the right leg. 4Provide feedback on the patient's strengths and available resources.

Provide feedback on the patient's strengths and available resources.

Which intervention should the nurse implement, when caring for the client who complains of phantom limb pain two months after amputation? 1Assess the stump for signs and symptoms of bleeding. 2Reassure the client that phantom pain is common. 3Assess the stump for signs and symptoms of infection. 4Reposition the stump, elevating it on two pillows.

Reassure the client that phantom pain is common.

Which intervention should the nurse implement, when caring for the client who complains of phantom limb pain two months after amputation? 1Reassure the client that phantom pain is common. 2Reposition the stump, elevating it on two pillows. 3Assess the stump for signs and symptoms of bleeding. 4Assess the stump for signs and symptoms of infection.

Reassure the client that phantom pain is common.

Which nursing intervention is essential in caring for a client with compartment syndrome? 1Starting an I.V. line in the affected extremity in anticipation of venogram studies 2 Wrapping the affected extremity with a compression dressing to help decrease the swelling 3 Keeping the affected extremity below the level of the heart 4Removing all external sources of pressure, such as clothing and jewelry

Removing all external sources of pressure, such as clothing and jewelry

Which nursing diagnosis takes highest priority for a client with a compound fracture? 1Imbalanced nutrition: Less than body requirements related to immobility 2Risk for infection related to effects of trauma 3Activity intolerance related to weight-bearing limitations 4Impaired physical mobility related to trauma

Risk for infection related to effects of trauma

Which nursing diagnosis takes highest priority for a client with a compound fracture?

Risk for infection related to effects of trauma A compound fracture involves an opening in the skin at the fracture site. Because the skin is the body's first line of defense against infection, any skin opening places the client at risk for infection. Imbalanced nutrition: Less than body requirements is rarely associated with fractures. Although Impaired physical mobility and Activity intolerance may be associated with any fracture, these nursing diagnoses don't take precedence because they aren't as life-threatening as infection.

Which nursing diagnosis is a priority for a client with a traumatically amputated lower extremity?

Risk for injury related to amputation

Which nursing diagnosis is a priority for a client with a traumatically amputated lower extremity? 1Risk for injury related to amputation 2Anticipatory grieving related to the loss of a limb 3Impaired skin integrity related to effects of the injury 4Disturbed body image related to changes in the structure of a body part

Risk for injury related to amputation

Which nursing diagnosis is a priority for a client with a traumatically amputated lower extremity?

Risk for injury related to amputation The priority diagnosis for this client is Risk for injury related to amputation. Patient safety takes priority. Amputation typically causes an unsteady gait until the client receives physical therapy and learns to ambulate safely. Impaired skin integrity, Anticipatory grieving, and Disturbed body image are also appropriate for a client presenting with a traumatic amputation of an extremity, but Risk for injury is the priority nursing diagnosis.

Second-degree sprain

A nurse is developing a teaching plan for a client who must undergo an above-the-knee amputation of the left leg. After a leg amputation, exercise of the remaining limb: 1Begins at a rehabilitation center. 2Should begin the day after surgery. 3Should begin immediately postoperatively. 4Isn't necessary.

Should begin the day after surgery

A 75-year-old patient had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which of the following complications? Select all that apply. 1Skin breakdown 2Sepsis 3Pneumonia 4 Delirium 5Necrosis of the humerus

Skin breakdown Sepsis Pneumonia Delirium

A 34-year-old client was playing a pick-up game of basketball when he became injured. He was brought to the urgent care facility where you practice nursing with an extremely painful elbow, which was very edematous. What type of injury would you suspect that the client experienced? 1Strain 2Contusion 3Sprain 4All options are correct.

Sprain

A client sustains an injury to the ligaments surrounding a joint. The nurse identifies this as which of the following?

Sprain

A client sustains an injury to the ligaments surrounding a joint. The nurse identifies this as which of the following? 1Contusion 2Strain 3Sprain 4Fracture

Sprain

A patient complains of pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The patient was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury?

Sprain

Which of the following terms refers to an injury to ligaments and other soft tissues of a joint? 1Strain 2Subluxation 3Sprain 4Dislocation

Sprain

Sprain A sprain is an injury to the ligaments and tendons surrounding a joint, usually caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear.

A client sustains an injury to the ligaments surrounding a joint. The nurse identifies this as which of the following?

Sprain A sprain is an injury to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A contusion is a soft tissue injury resulting from a blow or blunt trauma. A fracture is a break in the continuity of a bone.

Which term refers to an injury to ligaments and other soft tissues surrounding a joint?

Sprain A sprain is caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear.

A 45-year-old softball player arrives at the emergency department following his injury while sliding into a base during a game. After his examination and radiographs, the physician diagnoses muscle strain and prescribes appropriate treatment. What does the physician mean with the term "strain"? a) Stretched or pulled beyond capacity b) Subluxation of a joint c) Injuries to ligaments surrounding a joint d) Injury resulting from a blow or blunt trauma

Stretched or pulled beyond capacity Explanation: A strain is an injury to a muscle when it is stretched or pulled beyond its capacity.

Joe Blake, age 16 years, was playing soccer when he received an injury to the ligaments of his knee. He was brought to the emergency department because of pain, joint instability, and difficulty walking. His injury was judged not to require surgery. Which of the following interventions would not be included in his care? 1Ice and NSAIDs 2Traction 3Joint immobilization 4Limited weight bearing

Traction

A client sustains an injury to the left ankle when he fell down three steps. There was immediate swelling and pain from the injury, and the client was taken to the local emergency department. What initial test does the nurse anticipate the physician will order to rule out a fracture?

X-ray X-rays may show a larger-than-usual joint space and rule out or confirm an accompanying fracture. Arthrography demonstrates asymmetry in the joint as a result of the damaged ligaments, or arthroscopy may disclose trauma in the joint capsule. A CT scan is costly and not used as a first-line diagnostic tool in the initial stage of an ankle injury.

contusion A contusion is a soft tissue injury resulting from a blow or blunt trauma. Sprains are injuries to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A subluxation is a partial dislocation.

The patient presents to the emergency room with an open fracture of the femur. Which action would the nurse implement to prevent the most serious complication of an open fracture? 1Apply a pressure bandage to decrease tissue damage. 2Immobilize the joint to prevent movement of bone fragments. 3Cover the wound with a sterile dressing to prevent infection. 4Reduce the fracture to prevent additional tissue damage.

cover the wound with a sterile dressing to prevent infection.

Which is not one of the general nursing measures employed when caring for the client with a fracture?

cranial nerve assessment Cranial nerve assessment would only be carried out for head-related injuries or diseases. General nursing measures include administering analgesics, providing comfort measures, assisting with ADLs, preventing constipation, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing client for self-care.

immobilization Treatment of musculoskeletal trauma involves immobilization of the injured area until it has healed.

A client has been diagnosed with a muscle strain. What does the physician mean with the term "strain"?

stretched or pulled beyond its capacity A strain is an injury to a muscle when it is stretched or pulled beyond its capacity.

- skin breakdown - wound infection - pneumonia After surgery, the nurse implements measures to prevent skin breakdown, wound infection, pneumonia, constipation, urinary retention, muscle atrophy, and contractures.

c. Coughing and deep breathing with pillow splinting

15. A patient was climbing a ladder, slipped on a rung, and fell on the right side of the chest. X-ray studies reveal three rib fractures, and the patient is complaining of pain with inspiration. What is the anticipated treatment for this patient? a. Chest strapping b. Mechanical ventilation c. Coughing and deep breathing with pillow splinting d. Thoracentesis

The nurse is required to design a teaching plan for a client with a ruptured Achilles tendon. Which of the following would the nurse emphasize? 1Activity restrictions 2Effective pin care 3Use of nonprescription medications 4Dietary restrictions

Activity restrictions

Administer prescribed analgesics around-the-clock.

When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction? 1Apply ice to the fracture site. 2Use crutches for 1 week. 3Apply heat to the fracture site. 4Perform ankle dorsiflexion three times per day.

Apply ice to the fracture site.

When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction?

Apply ice to the fracture site. Applying ice to the injury site soon after an injury causes vasoconstriction, helping to relieve or prevent swelling and bleeding. Applying heat to the fracture site may increase swelling and bleeding. Ankle dorsiflexion has no therapeutic use after a toe fracture. It's unlikely the client would need crutches after a toe fracture.

A high school student who was injured in a football game presents with knee pain with internal rotation of the foot. Which of the following is an inappropriate nursing intervention?

Assist the client to "walk" off the pain.

A nurse is caring for a client who has sustained ligament and a meniscal injury to the knee. Which action would be most appropriate to allow the client to progress without causing further injury? 1Apply a cold pack to the affected area every night. 2Assist with a gradual introduction of activity. 3Apply heat to the affected area every night. 4Administer nonsteroidal anti-inflammatory drugs (NSAIDs) regularly.

Assist with a gradual introduction of activity.

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. The nurse would suspect which of the following?

Avascular necrosis

A client reports pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The client was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury? A Subluxation B Strain C Sprain D Dislocation

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for: 1Crepitus. 2Capillary refill. 3Shortening and deformity. 4Swelling and discoloration.

Capillary refill

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for:

Capillary refill. Assessment for neurovascular impairment includes checking for weak pulses or delayed capillary refill (normal is <2 seconds).

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? 1Compound 2Depressed 3Impacted 4Comminuted

Comminuted

Which type of fracture produces several bone fragments?

Comminuted

Which type of fracture produces several bone fragments? 1Incomplete 2Open 3Oblique 4Comminuted

Comminuted

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?

Comminuted A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment.

In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor in the client?

Compartment syndrome

Which assessment findings would cause the nurse to suspect compartment syndrome after casting of the leg?

Complaints of numbness and tingling in toes of affected leg Numbness and tingling indicate nerve ischemia and edema, suggesting development of compartment syndrome.

A patient who has extremity right wrist fracture complains of severe burning pain, frequent changes in the skin from hot and dry to cold and feeling clammy shiny skin that is growing more hair in the injured extremity. The nurse should anticipate providing care for what complication? 1Heterotrophic ossification 2Avascular necrosis of bone 3Reaction to an internal fixation device 4Complex regional pain syndrome (CRPS)

Complex regional pain syndrome (CRPS)

A patient who has extremity right wrist fracture complains of severe burning pain, frequent changes in the skin from hot and dry to cold and feeling clammy shiny skin that is growing more hair in the injured extremity. The nurse should anticipate providing care for what complication? 1Reaction to an internal fixation device 2Avascular necrosis of bone 3Complex regional pain syndrome (CRPS) 4Heterotrophic ossification

Complex regional pain syndrome (CRPS)

Compound

Contusion

Which of the following is a term used to describe a soft tissue injury produced by a blunt force?

Contusion

A 13-year-old client is brought to the emergency department. The client's mother reports that the client was struck with a baseball bat on his upper arm while diving for a pitched ball. After diagnostic tests are completed, the physician reassures the mother that her son's humerus is not broken but he has suffered another type of injury. What type of injury would you expect the physician to diagnose? a) Sprain b) Strain c) Contusion d) Subluxation

Contusion Explanation: A contusion is a soft tissue injury resulting from a blow or blunt trauma.

Which of the following is a term used to describe a soft tissue injury produced by a blunt force?

Contusion A contusion is a soft tissue injury produced by blunt force, such as a blow, kick, or fall, that results in bleeding into soft tissues (ecchymosis, or bruising). A hematoma develops when the bleeding is sufficient to form an appreciable solid swelling. A strain, or a "pulled muscle," is an injury to a musculotendinous unit caused by overuse, overstretching, or excessive stress. A sprain is an injury to the ligaments and supporting muscle fibers that surround a joint often caused by a trauma, wrenching or twisting motion.

The patient presents to the emergency room with an open fracture of the femur. Which action would the nurse implement to prevent the most serious complication of an open fracture?

Cover the wound with a sterile dressing to prevent infection. The most important complication of an open fracture is infection. Therefore, the wound is covered with a sterile dressing. No attempt is made to reduce the fracture or apply pressure.

Which term refers to the failure of fragments of a fractured bone to heal together? A Malunion B Dislocation C Subluxation D Nonunion

Which term refers to an injury to ligaments and other soft tissues surrounding a joint? A Strain B Dislocation C Subluxation D Sprain

D A sprain is caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear.

D After the acute inflammatory stage (e.g., 24 to 48 hours after injury), intermittent heat application (for 15 to 30 minutes, four times a day) relieves muscle spasm and promotes vasodilation, absorption, and repair.

Radiographs were ordered for a 10-year-old boy who had his right upper arm injured. The radiographs show that the humerus appears to be fractured on one side and slightly bent on the other. What type of fracture is this an example of? A Compound B Impacted C Compression D Greenstick (incomplete)

D Greenstick fractures are a result of the bone being broken on one side, while the other side is bent.

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? A "Apply ice packs for the first 12 to 18 hours." B "Apply heat packs for the first 24 to 48 hours." C "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours." D "Apply ice packs for the first 24 to 48 hours, then apply heat packs."

D The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.

Dislocated shoulder

Dislocated shoulder Clinical manifestations of a dislocated shoulder include pain, lack of motion, feeling of an empty shoulder socket, and uneven posture.

The nurses instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client?

Do not flex the hip more than 90 degrees. Proper alignment and supported abduction are encouraged for hip repairs. Flexion of the hip more than 90 degrees can cause damage to the a repaired hip fracture. By telling the patient to not to cross their legs, the leg stays in a the abducted position allowing for the hip to heal in the proper position. Having someone assist with the shoes does not allow for the hip to flex more than 90 degrees.

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?

Elevating the stump for the first 24 hours Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. Bed rest isn't indicated and could predispose the client to complications of immobility. Heat application would be inappropriate because it promotes vasodilation, which may cause hemorrhage and increase pain. The initial pressure dressing usually remains in place for 48 to 72 hours after surgery.

Fat emboli

Fat emboli After fracture of long bones or pelvic bones, or crush injuries, fat emboli frequently form. Fat embolism syndrome (FES) occurs when fat emboli cause morbid clinical manifestations. The classic triad of clinical manifestations of FES include hypoxemia, neurologic compromise, and a petechial rash (NAON, 2007), although not all signs and symptoms manifest at the same time (Tzioupis & Giannoudis, 2011). The typical first manifestations are pulmonary and include hypoxia and tachypnea.

Fat embolism syndrome The clinical manifestations described in the scenarion are characteristic of fat embolism syndrome.

Which of the following terms refers to a fracture in which one side of a bone is broken and the other side is bent? 1Greenstick 2Spiral 3Oblique 4Avulsion

Greenstick

When evaluating for hypovolemic shock, the nurse should be aware of which of the following clinical manifestations? a) Hypertension b) Bradycardia c) Bounding pulse d) Hypotension

Hypotension Explanation: The nurse should be alert to a weak pulse (thread), decreased blood pressure, decreased urine output, rapid, shallow respirations, and elevated heart rate.

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching? 1"I need to stay off my ankle for at least the next 3 to 4 weeks." 2"I'll get the prescription filled for the narcotic pain reliever." 3 "I'll make sure to keep my ankle elevated as much as possible." 4 "I'll start with ice for the first couple of hours and then apply heat."

I'll make sure to keep my ankle elevated as much as possible.

Which nursing diagnosis is the most appropriate for a client with a strained ankle?

Impaired physical mobility

Which type of fracture involves a break through only part of the cross-section of the bone? 1Incomplete 2Open 3Comminuted 4Oblique

Incomplete

A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture?

Incomplete A greenstick fracture involves a break through only part of the cross-section of the bone.

A nurse is caring for a client who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the client does what action to prevent common complications associated with a hip fracture?

Increase fluid intake and perform prescribed foot exercises.

A 39-year-old softball player has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would you expect the physician to perform? a) Analgesia and immobilization b) Joint manipulation and immobilization c) Heat and immobilization d) Ice and immobilization

Joint manipulation and immobilization Explanation: The physician manipulates the joint or reduces the displaced parts until they return to normal position, then immobilizes the joint with an elastic bandage, cast, or splint for several weeks.

A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?

Keeping a pillow between the client's legs at all times

Which of the following is an inaccurate clinical manifestation of a fracture? a) Lengthening b) Deformity c) Pain d) Crepitus

Lengthening Explanation: Clinical manifestations of a fracture include crepitus, deformity pain, shortening, and loss of function.

Which factor inhibits fracture healing?

Local malignancy Factors that inhibit fracture healing include local malignancy, bone loss, and extensive local trauma. Factors that enhance fracture healing include proper nutrition, vitamin D, exercise, and maximum bone fragment contact.

Which of the following is a factor that inhibits fracture healing? a) Vitamin D b) Maximum bone fragment contact c) Local malignancy d) Exercise

Local malignancy Explanation: Factors that inhibit fracture healing include local malignancy, bone loss, and extensive local trauma. Factors that enhance fracture healing include proper nutrition, vitamin D, exercise, and maximum bone fragment contact.

Which nursing intervention is appropriate for minimizing muscle spasms in the client with a hip fracture? 1Maintain Buck's traction. 2Apply a soft compression dressing. 3Assist the client with use of a trapeze. 4Maintain the internal fixator.

Maintain Buck's traction

The nurse is caring for an older woman with a hip fracture. The nurse recognizes that an incorrect risk factor for hip fracture is: 1Anemia 2Muscular agility 3 Female gender 4 Osteoporosis

Muscular agility

A client is brought to the emergency department after injuring his right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean? 1One side of the bone is broken and the other side is bent. 2The fracture results from an underlying bone disorder. 3The fracture line extends through the entire bone substance. 4Bone fragments are separated at the fracture line.

One side of the bone is broken and the other side is bent

A client with a traumatic amputation of the right lower leg is refusing to look at the leg. Which action by the nurse is most appropriate?

Provide feedback on the client's strengths and available resources. The nurse should encourage the client to look at, and assist with, care of the residual limb. Providing feedback on the client's strengths and resources may allow the client to start to adapt to the body image and lifestyle change. The nurse should also allow time for the client to discuss their feelings related to the amputation. Requesting a referral to occupational therapy and encouraging the client to perform ROM exercises are appropriate but do not address the emotional aspect of losing an extremity.

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain?

Rotator cuff tears

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain? 1Heterotopic ossification 2Acute compartment syndrome 3Epicondylitis 4Rotator cuff tears

Rotator cuff tears

Second-degree sprain

Which patient(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply. 1The patient using ice for pain control in the extremity 2The patient who sustained a clavicle fracture 3The patient with hemorrhage in the site of injury 4The patient with a plaster cast applied immediately after injury 5The patient with elevated pressure level within the muscles

The patient with elevated pressure level within the muscles The patient with hemorrhage in the site of injury The patient with a plaster cast applied immediately after injury

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

With the leg on the affected side abducted The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint.

A nurse advises a patient with a casted femur fracture to check for signs of a fat embolism. She tells the patient that the onset of symptoms for FES occur:

Within 12 to 48 hours. The onset of symptoms for a fat embolism is rapid, usually within 12 to 48 hours after injury, but may occur up to 10 days after injury.

A client has a fractured femur and is being seen in the emergency department. The nurse assessing the area notices there is a grating sound that is suspected to be bone ends moving over one another. This would be called:

crepitus. Crepitus is the grating sound of bone ends moving over one another, which may be audible (this term also refers to a popping sound caused by air trapped in soft tissue). False motion is unnatural motion that occurs at the site of the fracture. Spasm is the involuntary contraction of the muscles near the fracture. Deformity describes the unusual position or bending backward assumed by the extremity due to the break.

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include:

inability to perform active movement and pain with passive movement. With compartment syndrome, the client can't perform active movement, and pain occurs with passive movement. A body-wide decrease in bone mass is seen in osteoporosis. A growth in and around the bone tissue may indicate a bone tumor.

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include: a) body-wide decrease in bone mass. b) inability to perform active movement and pain with passive movement. c) a growth in and around the bone tissue. d) inability to perform passive movement and pain with active movement.

inability to perform active movement and pain with passive movement. Explanation: With compartment syndrome, the client can't perform active movement, and pain occurs with passive movement. A body-wide decrease in bone mass is seen in osteoporosis. A growth in and around the bone tissue may indicate a bone tumor.

A client is receiving subcutaneous heparin after surgery to repair a fractured hip. The nurse understands that the rationale for this therapy is to reduce the risk for:

pulmonary embolism Low-dose subcutaneous heparin therapy is used prophylactically to prevent pulmonary embolism. Elevation, ice, and frequent neurovascular checks help to provide early detection of compartment syndrome. Fluid and blood volume replacements are helpful in preventing shock. Careful monitoring for pain and decreased function may provide clues early on to the development of avascular necrosis.

A client is experiencing pain, joint instability, and difficulty walking due to an injury to the knee ligaments. The injury was judged not to require surgery. Which intervention would not be included in this client's care?

traction Joint immobilization, limited weight bearing, ice, and NSAIDs would be included in the initial treatment. Traction is not required because there is no break, and surgery is not required.

Choice Multiple question - Select all answer choices that apply. A bone graft may be used for which of the following reasons? Select all that apply. a) Improvement of motion b) Defect filling c) Stimulation of bone healing d) Joint stabilization e) Reduction of a fracture

• Joint stabilization • Defect filling • Stimulation of bone healing Explanation: A bone graft is used for joint stabilization, defect filling, or stimulation of bone healing. Tendon transfer is used for improving motion. Either closed or open reduction may be used to reduce a fracture.

d. 6 to 12 months

2. The nurse is caring for a patient after arthroscopic surgery for a rotator cuff tear. The nurse informs the patient that full activity can usually resume after what period of time? a. 3 to 4 weeks b. 8 weeks c. 3 to 4 months d. 6 to 12 months

c. III

4. A patient sustains an open fracture with extensive soft tissue damage. The nurse determines that this fracture would be classified as what grade? a. I b. II c. III d. IV

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client? A With the leg on the affected side abducted B With the affected hip rotated externally C With the leg on the affected side adducted D With the affected hip flexed acutely

A The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint.

The nurse is required to design a teaching plan for a client with a ruptured Achilles tendon. Which of the following would the nurse emphasize?

Activity restrictions The nurse should emphasize information about the activity restrictions, the use of ambulatory aids, and pain management to a client with a ruptured Achilles tendon. The client need not be advised about his or her diet or the use of nonprescription medications. Teaching about pin care is also not necessary for such a client because pins are not used to treat a ruptured Achilles tendon.

Which is one of the most common causes of death in clients diagnosed with fat emboli syndrome?

Acute respiratory distress syndrome Acute pulmonary edema and acute respiratory distress syndrome are the most common causes of death.

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. The nurse would suspect which of the following?

Avascular necrosis Avascular necrosis refers to the death of the bone from insufficient blood supply, typically manifested by complaints of increased pain and decreased function. Fever or redness, purulent drainage, and swelling of the site would suggest infection. Respiratory distress would suggest a pulmonary embolism. Changes in vital signs, level of consciousness, and signs and symptoms of fluid loss would suggest hypovolemic shock.

Which is a hallmark sign of compartment syndrome? A Weeping skin surfaces B Edema C Pain D Motor weakness

Which type of fracture involves a break through only part of the cross-section of the bone? A Comminuted B Open C Incomplete D Oblique

Compartment syndrome The nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable in a client with a dislocation to assess for compartment syndrome. It is a complication associated with dislocation. A client with a dislocation does not experience an increased risk of complications such as gastrointestinal bleeding, carpal tunnel syndrome, or ganglion cysts.

In a patient with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which of the following complications do the assessments help the nurse to monitor in the patient? a) Compartment syndrome b) GI bleeding c) Ganglion cysts d) Carpal tunnel syndrome

Compartment syndrome Explanation: The nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable in a patient with a dislocation to assess for compartment syndrome. It is a complication associated with dislocation. A patient with a dislocation does not experience an increased risk of complications such as GI bleeding, carpal tunnel syndrome, or ganglion cysts.

Which assessment findings would cause the nurse to suspect compartment syndrome after casting of the leg? a) Warm, pink foot and ability to move toes of affected leg b) Low-grade fever, dyspnea, tachycardia, and crackles c) Increased capillary refill and bounding pulses in affected leg d) Complaints of numbness and tingling in toes of affected leg

Complaints of numbness and tingling in toes of affected leg Explanation: Numbness and tingling indicate nerve ischemia and edema, suggesting development of compartment syndrome.

Which type of fracture is one in which the skin or mucous membrane extends to the fractured bone?

Compound A compound fracture is one in which the skin or mucous membrane wound extends to the fractured bone. A complete fracture involves a break across the entire cross section of the bone and is frequently displaced. An incomplete fracture involves a break through only part of the cross section of the bone. A simple fracture is one that does not cause a break in the skin.

Which of the following is a term used to describe a soft tissue injury produced by a blunt force? a) Sprain b) Hematoma c) Contusion d) Strain

Contusion Explanation: A contusion is a soft tissue injury produced by blunt force, such as a blow, kick, or fall, that results in bleeding into soft tissues (ecchymosis, or bruising). A hematoma develops when the bleeding is sufficient to form an appreciable solid swelling. A strain, or a "pulled muscle," is an injury to a musculotendinous unit caused by overuse, overstretching, or excessive stress. A sprain is an injury to the ligaments and supporting muscle fibers that surround a joint often caused by a trauma, wrenching or twisting motion.

The primary nursing intervention that will control swelling while treating a musculoskeletal injury is: A Immobilize the injured area. B Apply cold (moist or dry). C Apply an elastic compression bandage. D Elevate the affected area.

D The acronym RICE—Rest, Ice, Compression, Elevation—is helpful for remembering treatment interventions for musculoskeletal injuries. Rest prevents additional injury and promotes healing. Intermittent application of moist or dry cold packs for 20-30 minutes during the first 24-48 hours after injury produces vasoconstriction, which decreases bleeding, edema, and discomfort. Ensure care to avoid skin and tissue damage from excessive cold. An elastic compression bandage controls bleeding, reduces edema, and provides support for the injured tissues. Elevation controls the swelling.

A 39-year-old client has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicated intact but malpositioned bones, what would you expect the physician to diagnose? 1Fracture 2Sprain 3Dislocation 4Strain

Dislocation

Which of the following are general nursing measures for a patient with a fracture reduction? a) Promoting intake of omega-3 fatty acids b) Encourage participation in ADLs c) Examining the abdomen for enlarged liver or spleen d) Assisting with intake of immune-enhancing tube feeding formulas

Encourage participation in ADLs Explanation: General nursing measures for a patient with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation with ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the patient for self-care. Omega-3 fatty acids have no implications on the diet of a patient with a fracture reduction. The nurse should not examine the abdomen for enlarged liver or spleen since fracture reduction treatment does not affect these organs. It is unlikely that a patient with a fracture reduction will be prescribed immune-enhancing tube feeding formulas.

Which general nursing measure is used for a client with a fracture reduction?

Encourage participation in ADLs General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation in ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care. Omega-3 fatty acids have no implications on the diet of a client with a fracture reduction. The nurse does not need to examine the abdomen for enlarged liver or spleen because fracture reduction treatment does not affect these organs. It is unlikely that a client with a fracture reduction will be prescribed immune-enhancing tube feeding formulas.

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture?

Encourage participation in ADLs General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation with ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care. Omega-3 fatty acids have no implications on the diet of a client with a fracture reduction. Dependent positioning may increase edema because the extremity is below the level of the heart. While some pain medications may contribute to constipation, this intervention would be reserved for a client experiencing constipation and not as a preventative measure.

Which nursing intervention is appropriate for a patient with a closed reduction extremity fracture? 1Encouraging participation in ADLs 2Using frequent dependent positioning to prevent edema 3Administering prescribed enema to prevent constipation 4Promoting intake of omega-3 fatty acids

Encouraging participation in ADLs

Which of the following surgical procedures may need to be done when removing a cast or bandage does not restore circulation to the extremity?

Fasciotomy If pressure is not relieved by removing the bandage or cast and circulation is not restored, a fasciotomy may be necessary to relive the pressure within the muscle compartment. Hemiarthroplasty is the replacement of the femoral head with a prosthesis. An ORIF is done to reduce a fracture. A bone graft wound not be used to restore circulation.

A client with a fracture develops compartment syndrome that requires surgical intervention. The nurse would most likely prepare the client for which of the following?

Fasciotomy Surgical treatment of compartment syndrome is achieved with a fasciotomy, a surgical incision of the fascia and separation of the muscle to relieve pressure and restore tissue perfusion. Bone graft, joint replacement or amputation may be done for a client who experiences avascular necrosis.

Fat embolism syndrome

The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a patient who has sustained a fracture. The nurse suspects which complication? a) Fat embolism syndrome b) Hypovolemic shock c) Reflex sympathetic dystrophy syndrome d) Compartment syndrome

Fat embolism syndrome Explanation: Cerebral disturbances in the patient with fat embolism syndrome include subtle personality changes, restlessness, irritability, and confusion. With compartment syndrome, the patient complains of deep, throbbing, unrelenting pain. With hypovolemic shock, the patient would have a decreased blood pressure and increased pulse rate. Clinical manifestations of reflex sympathetic dystrophy syndrome include severe, burning pain, local edema, hyperesthesia, muscle spasms, and vasomotor skin changes.

Which of the following terms refers to a fracture in which one side of a bone is broken and the other side is bent? a) Avulsion b) Oblique c) Greenstick d) Spiral

Greenstick Explanation: A greenstick fracture is a fracture in which one side of a bone is broken and the other side is bent. A spiral fracture is a fracture twisting around the shaft of the bone. An avulsion is the pulling away of a fragment of bone by a ligament or tendon and its attachment. An oblique is a fracture occurring at an angle across the bone.

The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury?

Hypovolemic Hypovolemic shock resulting from hemorrhage is more frequently noted in trauma patients with pelvic fractures and in patients with a displaced or open femoral fracture in which the femoral artery is torn by bone fragments.

The nurse is caring for a patient who sustained an open fracture of the right femur in an automobile accident. What does the nurse understand is the most serious complication of an open fracture?

Infection

The nurse is caring for a patient who sustained an open fracture of the right femur in an automobile accident. What does the nurse understand is the most serious complication of an open fracture? 1Nerve damage 2Necrosis of adjacent soft tissue caused by blood loss 3Infection 4Muscle atrophy caused by loss of supporting bone structure

Infection

A client experienced an open fracture to the left femur during a horse-riding accident. For which complication is this client at highest risk?

Infection This client is at the highest risk for infection because of the open fracture that was obtained while horseback riding. Infection that enters the body and affects the bone can lead to osteomyelitis. The treatment may involve long-term antibiotics and may even result in death. The client is still at risk for malunion, but this risk is slight because the bone can be visualized (either through the wound or surgical intervention) and returned to anatomical position. The other options are possible consequences of this type of injury but do not represent the most serious complication.

An emergency department nurse is assessing a 17-year-old soccer player who presented with a knee injury. The client's description of the injury indicates that his knee was struck medially while his foot was on the ground. The nurse knows that the client likely has experienced what injury?

Lateral collateral ligament injury

Which nursing intervention is appropriate for minimizing muscle spasms in the client with a hip fracture? a) Assist the client with use of a trapeze. b) Maintain the internal fixator. c) Apply a soft compression dressing. d) Maintain Buck's traction.

Maintain Buck's traction. Explanation: Buck's traction decreases pain, muscle spasm, and external rotation by immobilizing the hip fracture.

The nurse is caring for an older woman with a hip fracture. The nurse recognizes that an incorrect risk factor for hip fracture is:

Muscular agility Muscular agility decreases the risk for hip fracture. The other choices are all risk factors for hip fracture.

A 17-year-old high school junior was involved in a motor-vehicle collision and brought to the ED via squad. His left arm was severely traumatized in the accident and he was taken immediately to surgery. He is admitted to the ICU where you practice nursing and the physician has ordered close monitoring for compartment syndrome. What musculoskeletal structure does compartment syndrome affect? a) Nerve b) All options are correct c) Bone d) Ligament

Nerve Correct Explanation: Compartment syndrome affects nerve innervation, leading to subsequent palsy (decreased sensation and movement).

When joint manipulation is unsuccessful for a client, he is taken to surgery for surgical repair of his hip injury. He is brought to the ICU where you practice nursing for postoperative recovery. In addition to the regular assessments prescribed by policy, what assessment is completed every 30 minutes for several hours? a) Neurological b) Neurovascular c) Orientation d) Head-to-toe

Neurovascular Explanation: The nurse should perform neurovascular assessments every 30 minutes for several hours, and then at least every 2 to 4 hours for the next 1 or 2 days to detect complications.

When caring for a client with a fracture, assessment of which of the following would be the priority? 1Neurovascular compromise 2Cardiac problems 3Hormonal imbalances 4Altered kidney function

Neurovascular compromise

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment? 1Malunion 2Nonunion 3Delayed union 4Subluxation

Nonunion

A client is brought to the emergency department by ambulance after stepping in a hole and falling. While assessing him the nurse notes that his right leg is shorter than his left leg; his right hip is noticeably deformed and he is in acute pain. Imaging does not reveal a fracture. What is the most plausible explanation for this client's signs and symptoms?

Traumatic hip dislocation

Which of the following may occur if a client experiences compartment syndrome in an upper extremity?

Volkmann's contracture If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a clawlike deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation.

Which of the following may occur if a client experiences compartment syndrome in an upper extremity? a) Volkmann's contracture b) Callus c) Subluxation d) Whiplash injury

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

"Apply ice packs for the first 24 to 48 hours, then apply heat packs." The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? a) "The occupational therapist is showing me how to use a sock puller to help me get dressed." b) "I'll need to keep several pillows between my legs at night." c) "I need to remember not to cross my legs. It's such a habit." d) "I don't know if I'll be able to get off that low toilet seat at home by myself."

"I don't know if I'll be able to get off that low toilet seat at home by myself." Explanation: The client requires additional teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Teaching the client to avoid crossing the legs also reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees.

A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications? Select all that apply.

- Pneumonia - Skin breakdown - Sepsis - Delirium Complications in clients with hip fractures are often related to the client's age. During the first 24 to 48 hours following surgery for hip fracture, atelectasis or pneumonia can develop as a result of the anesthesia. Thromboemboli are possible, as is sepsis. Elderly clients are also at risk for delirium in hospital settings because of the stress of the trauma, unfamiliar surroundings, sleep deprivation, and medications. An elderly client with decreased mobility is at risk for skin breakdown. Necrosis is a potential complication of the surgery, but the complication would be with the femur, not the humerus.

b. Between 24 and 48 hours

1. A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last? a. Less than 24 hours b. Between 24 and 48 hours c. About 72 hours d. At least 1 week

d. Volkmann's ischemic contracture

10. A patient falls while skiing and sustains a supracondylar fracture. What does the nurse know is the most serious complication of a supracondylar fracture of the humerus? a. Hemarthrosis b. Paresthesia c. Malunion d. Volkmann's ischemic contracture

b. Hemorrhage and shock

11. While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures? a. Paresthesia and ischemia b. Hemorrhage and shock c. Paralytic ileus and a lacerated urethra d. Thrombophlebitis and infection

a. Checking the urine for hematuria b. Palpating peripheral pulses in both lower extremities c. Testing the stool for occult blood

12. The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture should be included? (Select all that apply.) a. Checking the urine for hematuria b. Palpating peripheral pulses in both lower extremities c. Testing the stool for occult blood d. Assessing level of consciousness e. Assessing pupillary response

a. Hypovolemic shock

13. A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient? a. Hypovolemic shock b. Infection c. Knee and hip dislocation d. Pain resulting from muscle spasm

a. Encouraging the patient to care for the residual limb b. Allowing the expression of grief e. Introducing the patient to local amputee support groups.

14. A nurse is caring for a patient who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.) a. Encouraging the patient to care for the residual limb b. Allowing the expression of grief c. Encourage the patient to have family & friends view the residual limb to decrease self-consciousness. d. Encouraging family & friends to refrain from visiting temporarily because this may increase the patient's embarrassment. e. Introducing the patient to local amputee support groups.

24 to 48 hours.

24 to 48 hours. Rest and ice applications during the first 24 to 48 hours produce vasoconstriction while decreasing bleeding and edema. After this time, the acute inflammatory stage decreases. Refer to Box 42-1 in the text.

b. Apply a tourniquet.

3. A patient had an above-the-knee amputation of the left leg related to complications from PVD. The nurse enters the patient's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse? a. Notify the physician. b. Apply a tourniquet. c. Use skin clips to close the wound. d. Reinforce the dressing.

a. Covering the area with a clean dressing if the fracture is open b. Immobilizing the affected site c. Splinting the injured limb

5. A patient sustains an open fracture of the left arm after an accident at the roller skating rink. What does emergency management of this fracture involve? (Select all that apply.) a. Covering the area with a clean dressing if the fracture is open b. Immobilizing the affected site c. Splinting the injured limb d. Asking the patient if he or she is able to move the arm e. Wrapping the arm in an ace bandage

The nurse is caring for a patient after arthroscopic surgery for a rotator cuff tear. The nurse informs the patient that full activity can usually resume after what period of time? 1 6 to 12 months 2 8 weeks 3 3 to 4 months 4 3 to 4 weeks

6 to 12 months

6 to 8 weeks Following surgical repair for a ruptured Achilles tendon, the client wears a brace or cast for 6 to 8 weeks.

a. Infection

6. The nurse is caring for a patient who sustained an open fracture of the right femur in an automobile accident. What does the nurse understand is the most serious complication of an open fracture? a. Infection b. Muscle atrophy caused by loss of supporting bone structure c. Necrosis of adjacent soft tissue caused by blood loss d. Nerve damage

b. Hypovolemic

7. The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury? a. Cardiogenic b. Hypovolemic c. Neurogenic d. Septicemic

a. As soon as tolerated, after a reasonable period of immobilization

9. A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin? a. As soon as tolerated, after a reasonable period of immobilization b. In 2 to 3 weeks, when callus ossification prevents easy movements of bony fragments c. In about 4 to 5 weeks, after new bone is well established d. In 2 to 3 months, after normal activities are resumed

The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding? A Clawlike deformity of the right hand without ability to extend fingers B Nodules on the knuckles of the third and fourth finger C Extension of the fingers of the right hand D Dislocation of the fingers

A A Volkmann's contracture is a claw like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. The client is unable to extend the fingers and complains of unrelenting pain, particularly if attempting to stretch the hand

A A partial dislocation is referred to as a subluxation. A Volkmann's contracture is a claw like deformity that results from compartment syndrome or obstructed arterial blood flow to the forearm and hand. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space and affects nerve innervation, leading to subsequent palsy. A sprain is injury to the ligaments surrounding the joint.

A client has been involved in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. Other than the bone, what physical structures could be affected by this injury?

All options are correct. A fractured bone or other injury can potentially cause dysfunction to the surrounding muscle and injury to the blood vessels and nerves.

After an arm fracture, the nurse practitioner advises the patient that pendulum exercises are begun: 1In 2 to 3 months, after normal activities are resumed. 2As soon as tolerated, after a reasonable period of immobilization. 3In about 4 to 5 weeks, after new bone is well established. 4In 2 to 3 weeks, when callus ossification prevents easy movements of bony fragments.

As soon as tolerated, after a reasonable period of immobilization

After an arm fracture, the nurse practitioner advises the patient that pendulum exercises are begun:

As soon as tolerated, after a reasonable period of immobilization. The immediacy of physical therapy is essential to a rapid recovery.

Which nursing intervention is appropriate for monitoring the client for the development of Volkmann's contracture?

Assess the radial pulse. Volkmann's contracture is a type of acute compartment syndrome that occurs with a supracondylar fracture of the humerus. The nurse assesses neurovascular function of the hand and forearm.

A patient is transported to the ED for a femur fracture following a motor vehicle crash. What action by the nurse is the highest priority? 1Assess the diameter of the thigh every 15 minutes. 2Administer pain medication per orders. 3Assess pedal pulses. 4Assess vital signs and level of consciousness.

Assess vital signs and level of consciousness

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect? A Infection B Avascular necrosis C Hypovolemic shock D Pulmonary embolism

B Avascular necrosis refers to the death of the bone from insufficient blood supply, typically manifested by complaints of increased pain and decreased function. Fever or redness, purulent drainage, and swelling of the site would suggest infection. Respiratory distress would suggest a pulmonary embolism. Changes in vital signs, level of consciousness, and signs and symptoms of fluid loss would suggest hypovolemic shock.

A client who suffers an injury in a local high school hockey game presents with left shoulder pain. The client cannot move the left arm, and the left shoulder is lower than the right shoulder. The nurse recognizes the client most likely has a: A Cervical injury B Dislocated shoulder C Clavicle fracture D Dislocated elbow

B Clinical manifestations of a dislocated shoulder include pain, lack of motion, feeling of an empty shoulder socket, and uneven posture

Between 24 and 48 hours After the acute inflammatory stage (e.g., 24 to 48 hours after injury), intermittent heat application (for 15 to 30 minutes, four times a day) relieves muscle spasm and promotes vasodilation, absorption, and repair.

Which nursing intervention is essential in caring for a client with compartment syndrome? A Starting an I.V. line in the affected extremity in anticipation of venogram studies B Wrapping the affected extremity with a compression dressing to help decrease the swelling C Removing all external sources of pressure, such as clothing and jewelry D Keeping the affected extremity below the level of the heart

The nurse is assessing a patient's right knee, and the assessment reveals edema, tenderness, muscle spasms, and ecchymosis. The patient states that 2 days ago he ran a half marathon and now it is painful to stand up. Based upon these symptoms, the nurse should plan care based upon the fact that the patient has likely experienced what? A. 1st degree strain B. 1st degree sprain C. 2nd degree strain D. 2nd degree sprain

C A second-degree strain involves tearing of muscle fibers and is manifested by notable loss of load-bearing strength with accompanying edema, tenderness, muscle spasm, and ecchymosis. A first-degree strain reflects tearing of few muscle fibers and is accompanied by minor edema, tenderness, and mild muscle spasm, without noticeable loss of function

A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states that he cannot feel or move his fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures?

Compartment syndrome Separation of adjacent bones from their articulating joint interferes with normal use and produces a distorted appearance. The injury may disrupt local blood supply to structures such as the joint cartilage, causing degeneration, chronic pain, and restricted movement. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space. The fractured humerus may also be dislocated but is not the result of the impaired circulatory status. Muscle spasms may occur around the fracture site but are not the cause of circulatory impairment. Subluxation is a partial dislocation.

Dislocation Explanation: In joint dislocation, radiographic films show intact yet malpositioned bones.

In a patient with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which of the following complications do the assessments help the nurse to monitor in the patient? 1Carpal tunnel syndrome 2Fat embolism syndrome 3Compartment syndrome 4Disseminated intravascular coagulation

Disseminated intravascular coagulation

Which of the following terms refers to failure of fragments of a fractured bone to heal together? 1Subluxation 2Nonunion 3Dislocation 4Malunion

Nonunion

Which term refers to the failure of fragments of a fractured bone to heal together?

Nonunion

Which term refers to the failure of fragments of a fractured bone to heal together?

Nonunion When nonunion occurs, the client reports persistent discomfort and movement at the fracture site. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Malunion refers to growth of the fragments of a fractured bone in a faulty position, forming an imperfect union.

Ch42

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