Chapter 61: Caring for Clients Requiring Orthopedic Treatment

A client who had a total hip replacement two days ago reports new onset calf tenderness to the nurse. Which action should the nurse take? a) Administer pain medication. b) Massage the client's calf. c) Apply antiembolic stockings. d) Notify the health care provider.

d) Notify the health care provider.

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? a) Arthrodesis b) Joint arthroplasty c) Total joint arthroplasty d) Open reduction

d) Open reduction

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period? a) osteomyelitis b) hematoma c) hemorrhage d) infection

a) osteomyelitis

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? a) Atelectasis b) Hypovolemia c) Pulmonary embolism d) Urinary tract infection

c) Pulmonary embolism

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

a) "CPM increases range of motion of the joint."

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? a) 24 hours b) 72 hours c) 1 week d) 2 to 3 weeks

a) 24 hours

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

a) Keep the cast clean and dry.

A client was brought to the emergency department after a fall. The client is taken to the operating room to receive a right hip prosthesis. In the immediate postoperative period, what health education should the nurse emphasize? a) "Make sure you don't bring your knees close together." b) "Try to lie as still as possible for the first few days." c) "Try to avoid bending your knees until next week." d) "Keep your legs higher than your chest whenever you can."

a) "Make sure you don't bring your knees close together."

While assessing a client who has had knee replacement surgery, the nurse notes that the client has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this client? a) Risk for Infection b) Risk for Ineffective Peripheral Tissue Perfusion c) Unilateral Neglect Related to Hematoma d) Disturbed Kinesthetic Sensory Perception

b) Risk for Ineffective Peripheral Tissue Perfusion

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

b) Sharp and piercing

A client is admitted to the orthopedic unit in skeletal traction for a fractured proximal femur. Which explanation should the nurse give the client about skeletal traction? a) "Skeletal traction temporarily stabilizes the fracture before surgery." b) "Weights are attached to the leg using a boot." c) "Traction involves passing a pin through the bone." d) "Light weights must be used with skeletal traction."

c) "Traction involves passing a pin through the bone."

A client with a total hip replacement has developed decreased breath sounds. What is the nurse's best action? a) Place the client on bed rest. b) Request an antitussive medication from the health care provider. c) Encourage use of the incentive spirometer. d) Assess for signs and symptoms of systemic infection.

c) Encourage use of the incentive spirometer.

The nurse is caring for a client who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis? a) Keep the affected leg in a position of adduction. b) Have the client reposition himself independently. c) Protect the affected leg from internal rotation. d) Keep the hip flexed by placing pillows under the client's knee.

c) Protect the affected leg from internal rotation.

The nurse is teaching the client on bed rest to perform quadriceps setting exercises. Which instruction should the nurse give the client? a) "Push the knees into the mattress." b) "Lie prone in bed." c) "Contract the buttock muscles." d)"Bend the knees."

d) "Bend the knees."

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

d) Teach the client how to prevent problems caused by immobility.

A client has a compound fracture of the right femur. Due to the nature of the fracture, open reduction will be used to align the femur. What other rationale requires the use of open reduction? a) All options are correct. b) Wound débridement is necessary. c) Fracture causes wide bone separation. d) Fracture involves several, small pieces of bone.

a) All options are correct.

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

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

A nurse is caring for a client with a cast on the left arm after sustaining a fracture. Which assessment finding is most significant for this client? a) Fingers on the left hand are swollen and cool b) Presence of a normal popliteal pulse Cast edges are rough, with skin irritation present c) Minimal pain in the left arm

a) Fingers on the left hand are swollen and cool

The nursing care plan for a client in traction specifies regular assessments for venous thromboembolism (VTE). When assessing a client's lower limbs, what sign or symptom is suggestive of deep vein thrombosis (DVT)? a) Increased warmth of the calf b) Decreased circumference of the calf c) Loss of sensation to the calf d) Pale-appearing calf

a) Increased warmth of the calf

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

a) Instruct the client to avoid internal rotation of the leg.

A client who has a fractured femur has been put in traction and requires assistance with care activities. A nursing diagnosis associated with the client's procedure is "Impaired Tissue Integrity related to puncture wound from pin placement." Which intervention would not be incorporated into the client's care related to this diagnosis? a) Monitor bowel function daily. b) Protect bony prominences from pressure using pressure-relieving techniques under elbows, heels, and coccyx. c)Assess traction frequently to ensure proper alignment and to prevent pressure areas. d) Provide pin care per agency protocol.

a) Monitor bowel function daily.

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

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

Which statement about traction pin care is incorrect? a) The pin should be cleaned from the distal point inward toward the insertion site. b) Gently remove crusts from around pin sites. c) Use at least one applicator per pin; do not use applicator more than once. d)Using aseptic technique, the nurse or caretaker uses cotton-tipped applicators and sterile water, saline, or other prescribed solution, such as chlorhexidine solution, to cleanse pin sites.

a) The pin should be cleaned from the distal point inward toward the insertion site.

The orthopedic surgeon has prescribed balanced skeletal traction for a client. What advantage is conferred by balanced traction? a) Balanced traction can be applied at night and removed during the day. b) Balanced traction allows for greater client movement and independence than other forms of traction. c) Balanced traction is portable and may accompany the client's movements. d) Balanced traction facilitates bone remodeling in as little as 6 days.

b) Balanced traction allows for greater client movement and independence than other forms of traction.

Which would be consistent as a component of self-care activities for the client with a cast? a) Cover the cast with plastic to insulate it b) Cushion rough edges of the cast with tape c) Frequently place the casted extremity in a dependent position d) Use a plastic hanger wrapped in gauze to scratch under the cast.

b) Cushion rough edges of the cast with tape

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

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

A nurse is caring for a client after stabilization of a radial fracture. Which actions by the nurse would be appropriate for the client following arm casting? Select all that apply. a) Elevate the arm on a plastic-covered pillow b) Protect the cast by covering with a sheet c) Handle the cast with the palms of hands d) Circulate room air with a portable fan e) Petal and smooth the edges of the cast

b) Protect the cast by covering with a sheet c) Handle the cast with the palms of hands d) Circulate room air with a portable fan e) Petal and smooth the edges of the cast

A 91-year-old client is slated for orthopedic surgery and the nurse is integrating gerontologic considerations into the client's plan of care. What intervention is most justified in the care of this client? a) Administration of prophylactic antibiotics b) Total parenteral nutrition (TPN) c) Use of a pressure-relieving mattress d) Use of a Foley catheter until discharge

c) Use of a pressure-relieving mattress

A nurse is caring for a client who is in skeletal traction. To prevent the complication of skin breakdown in a client with skeletal traction, what action should be included in the plan of care? a) Apply occlusive dressings to the pin sites. b) Encourage the client to push up with the elbows when repositioning. c) Encourage the client to perform isometric exercises once a shift. d) Assess the pin insertion site every 8 hours.

d) Assess the pin insertion site every 8 hours.

A nurse is planning the care of a client who has undergone orthopedic surgery. What main goal should guide the nurse's choice of interventions? a) Improving the client's level of function b) Helping the client come to terms with limitations c) Administering medications safely d) Improving the client's adherence to treatment

d) Improving the client's level of function

Which is an inaccurate principle of traction? a) The weights are not removed unless intermittent treatment is prescribed. b) The weights must hang freely. c) The client must be in good alignment in the center of the bed. d) Skeletal traction is interrupted to turn and reposition the client.

d) Skeletal traction is interrupted to turn and reposition the client.

A nurse is caring for a client who has had a plaster arm cast applied. Immediately after application, the nurse should provide what teaching to the client? a) The cast will feel cool to touch for the first 30 minutes. b) The cast should be wrapped snuggly with a towel until the client gets home. c) The cast should be supported on a board while drying. d) The cast will only have full strength when dry.

d) The cast will only have full strength when dry.

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

a) Abduction

The nurse is caring for a client who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis? a)Keep the affected leg in a position of adduction. b)Have the client reposition himself independently. c)Protect the affected leg from internal rotation. d)Keep the hip flexed by placing pillows under the client's knee.

c) Protect the affected leg from internal rotation.

An elderly client's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment? a) The presence of leg shortening b) The client's complaints of pain c) Signs of neurovascular compromise d)The presence of internal or external rotation

c) Signs of neurovascular compromise

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

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

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

a) physical therapy

An elderly client's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment? a) The presence of leg shortening b) The client's complaints of pain c) Signs of neurovascular compromise d) The presence of internal or external rotation

c) Signs of neurovascular compromise

A nurse is caring for a client who has a leg cast. The nurse observes the client using a pencil to scratch the skin under the edge of the cast. How should the nurse respond to this observation? a) Allow the client to gently scratch inside the cast with a pencil. b) Give the client a sterile tongue depressor to use for scratching instead of the pencil. c) Provide a fan to blow cool air into the cast to relieve itching. d) Obtain a prescription for a sedative, such as lorazepam, to prevent the client from scratching.

c) Provide a fan to blow cool air into the cast to relieve itching.

Which device is designed specifically to initially support and immobilize a body part in a desired position until swelling subsides? a) Brace b) Continuous passive motion (CPM) device c) Splint d) Trapeze

c) Splint

A client with a fractured femur is placed in skeletal traction. Which intervention will increase client independence when moving in bed? a) Apply a trapeze to the bed frame. b) Instruct to use the elbows to reposition. c) Remove the weights prior to repositioning. d) Remind to use the heel of the unaffected foot to reposition.

a) Apply a trapeze to the bed frame.

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

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

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

a) Cover the cast with plastic to insulate it

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

a) Cut a cast window.

A nurse is admitting a client to the unit who presented with a lower extremity fracture. What signs and symptoms would suggest to the nurse that the client may have a peroneal nerve injury? a) Numbness and burning of the foot b) Pallor to the dorsal surface of the foot c) Visible cyanosis in the toes d) Inadequate capillary refill to the toes

a) Numbness and burning of the foot

A nurse is caring for a client who is postoperative day 1 following a total arthroplasty of the right hip. How should the nurse position the client? a) Place a pillow between the legs. b) Turn the client on the surgical side. c) Avoid flexion of the right hip. d) Keep the right hip adducted at all times.

a) Place a pillow between the legs.

The nurse is helping to set up Buck's traction on an orthopedic client. How often should the nurse assess circulation to the affected leg? a) Within 30 minutes, then every 1 to 2 hours b) Within 30 minutes, then every 4 hours c) Within 30 minutes, then every 8 hours d) Within 30 minutes, then every shift

a) Within 30 minutes, then every 1 to 2 hours

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

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

A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse? a) "You would have to stay here much longer because it takes a cast longer to dry." b) "A splint is applied when more swelling is expected at the site of injury." c) "It is best if an orthopedic doctor applies the cast." d) "Not all fractures require a cast."

b) "A splint is applied when more swelling is expected at the site of injury."

A client with a right tibial fracture is being discharged home after having a cast applied. What instruction should the nurse provide in relationship to the client's cast care? a) "Cover the cast with a blanket until the cast dries." b) "Keep your right leg elevated above heart level." c) "Use a clean object to scratch itches inside the cast." d) "A foul smell from the cast is normal after the first few days."

b) "Keep your right leg elevated above heart level."

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

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

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

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

A client with a fractured femur is in balanced suspension traction. The client needs to be repositioned toward the head of the bed. During repositioning, what should the nurse do? a) Place slight additional tension on the traction cords. b) Release the weights and replace them immediately after positioning. c) Reposition the bed instead of repositioning the client. d) Maintain consistent traction tension while repositioning.

d) Maintain consistent traction tension while repositioning.

A nurse is assessing the neurovascular status of a client who has had a leg cast recently applied. The nurse is unable to palpate the client's dorsalis pedis or posterior tibial pulse and the client's foot is pale. What is the nurse's most appropriate action? a) Warm the client's foot and determine whether circulation improves. b) Reposition the client with the affected foot dependent. c) Reassess the client's neurovascular status in 15 minutes. d) Promptly inform the primary care provider.

d) Promptly inform the primary care provider.

A nurse is giving instructions to a client who's going home with a leg cast. Which teaching point is most critical? a) Using crutches properly b) Exercising joints above and below the cast, as ordered c) Avoiding walking on a leg cast without the health care provider's permission d) Reporting signs of impaired circulation

d) Reporting signs of impaired circulation