EXAM FOUR (MED-SURG 1)
The following describe what injury? •Orthopedic emergency •Obvious deformity
Dislocation
The following describes what injury? "clicks, pops, locks, gives-way" Positive McMurray's test: Pain with flexion, internal rotation, and extension of knee
Meniscus Tear
Which information will the nurse teach seniors at a community recreation center about ways to prevent fractures? A. Tack down scatter rugs in the home. B. Expect most falls to happen outside the home. C. Buy shoes that provide good support and are comfortable to wear. D. Get instruction in range-of-motion exercises from a physical therapist
Answer: C - Comfortable shoes with good support will help decrease the risk for falls. •Why the other options are wrong: •A- Scatter rugs should be eliminated, not just tacked down. •B- Falls inside the home are responsible for many injuries. •D- Activities of daily living provide range of motion exercise; these do not need to be taught by a physical therapist.
Prior to starting alendronate, the nurse should assess which of the following in the client? A. Ability to swallow B. Baseline Vision C. The client's ability to lay flat D. Absence of nasal dryness
A. Ability to swallow B. Baseline Vision Alendronate is a contraindication in clients who have difficulty swallowing due to the risk of esophagitis. Alendronate can cause vision changes in some clients, so it would be important to know the client's baseline vision to assess for changes during drug therapy. The client must be able to tolerate sitting in an upright position for 30 minutes following administration of alendronate. Alendronate is not administered intranasally and does not affect the client's nostrils.
A 3-month-old has just had casts applied to the left foot. The nurse knows to assess for symptoms of compartment syndrome and would be concerned about which of the following? Select all that apply. A. Delayed capillary refill distal to the cast B. Tight, shiny skin distal to the cast C. Inability to palpate a pulse distal to the cast D. Warm skin proximal to the cast E. Palpable pulses proximal to the cast
A. Delayed capillary refill distal to the cast B. Tight, shiny skin distal to the cast C. Inability to palpate a pulse distal to the cast
A patient with rheumatoid arthritis is taking methotrexate. Toxicity from methotrexate may be reduced with which of the following? A. Folic Acid B. Magnesium Sulfate C. Ferrous Sulfate D. Niacin
A. Folic Acid Folic acid may reduce the toxic effects of methotrexate. The client should take 5 milligrams or more of folic acid supplement per week. Magnesium sulfate helps relieve acute constipation. Ferrous sulfate corrects iron deficiency anemia. Vitamin B3 has many therapeutic uses, including the prevention and treatment of pellagra, a nutritional deficiency with many dermatologic manifestations.
A patient is given raloxifene (Evista), a selective estrogen receptor modulator (SERM), to treat osteoporosis. Which of the following is an adverse effect of raloxifene. A. Hot flashes B. Breast cancer C. Blurred vision D. Jaw pain
A. Hot flashes Raloxifene, a selective estrogen receptor modulator that helps reduce the risk of breast cancer, may cause hot flashes, leg cramps, and pulmonary embolism. Bisphosphonates can cause jaw pain and blurred vision.
A nurse is caring for a client taking etanercept. Which of the following adverse effects is MOST important to mention when educating this client? A. Injection site reaction can occur. B. Elevation of liver enzymes can occur. C. Gastric perforation can occur. D. Vision changes can occur.
A. Injection site reaction can occur. Injection site reaction occurs in 37% of clients taking etanercept. Teach the client to look for localized reaction signs, such as itching, erythema, swelling, and pain. Elevation of liver enzymes is an adverse effect of the drug leflunomide. Gastrointestinal perforation has been associated with the drug methotrexate. Change in vision is an adverse effect of alendronate.
Which of the following drugs are effective in disease prevention as well as treatment of osteoporosis? A. Raloxifene B. Calcitonin-salmon C. Alendronate D. NSAIDs
A. Raloxifene C. Alendronate The Selective Estrogen Receptor Modulator (SERM) raloxifene is used in both the prevention and treatment of postmenopausal osteoporosis. Alendronate, a bisphosphonate, is used in the prevention and treatment of postmenopausal osteoporosis, age-related osteoporosis in men, and glucocorticoid-related osteoporosis in clients taking glucocorticoids long term. Calcitonin-salmon is used in the treatment, not prevention, of established postmenopausal osteoporosis. NSAIDs treat symptoms of a disease and are not effective in prevention.
The community health nurse is educating a group of individuals about osteoporosis. Which of the following are risk factors for osteoporosis? Select all that apply. A. Steroid use B. Being an older adult C. Being post-menopausal D. Long-term antacid use E. Being male
A. Steroid use B. Being an older adult C. Being post-menopausal D. Long-term antacid use
The nurse is caring for a patient with a fasciotomy of their right lower leg. Which of the following interventions should the nurse include in the plan of care? A.Perform aseptic dressing changes Q4H B.Draw a WBC daily C.Elevate the extremity D.Perform passive range of motion
Answer - B. Patients with fasciotomies are at a high risk of developing an infection. It is very important that the nurse monitor for s/sx of infection. •Why the others are wrong: oA - Fasciotomies need sterile care, not aseptic. Fasciotomies are also left open, not covered in a dressing. o C- elevating the extremity will worsen compartment syndrome. This would also be handling the extremity more than necessary, which is painful and poses risk for infection. o D - Passive ROM would be excruciatingly painful for this patient and pose further infection risk.
Which action will the nurse take in order to evaluate the effectiveness of Buck's traction for a patient who has an intracapsular fracture of the right femur? •A. Assess for hip pain. •B. Assess for contractures. •C. Check peripheral pulses. •D. Monitor for hip dislocation.
Answer: A - Buck's traction keeps the leg immobilized and reduces painful muscle spasm. Why the other options are wrong: •B & D - Hip contractures and dislocation are unlikely to occur in this situation. •C - The peripheral pulses will be assessed, but this does not help in evaluating the effectiveness of Buck's traction.
A patient with a right lower leg fracture will be discharged home with an external fixation device in place. Which information will the nurse teach? •A "Check and clean the pin insertion sites daily." •B. "Remove the external fixator for your shower." •C. "Remain on bed rest until bone healing is complete." •D. "Take prophylactic antibiotics until the fixator is removed."
Answer: A - Pin insertion sites should be cleaned daily to decrease risk for infection at the site. Why the other options are wrong: •B - The device is surgically placed and is not removed until the bone is stable •C - An external fixator allows the patient to be out of bed and avoid the risks of prolonged immobility. •D - Prophylactic antibiotics are not routinely given during external fixator use.
A patient who has had open reduction and internal fixation (ORIF) of left lower leg fractures continues to complain of severe pain in the leg 15 minutes after receiving the prescribed IV morphine. Pulses are faintly palpable and the foot is cool to the touch. Which action should the nurse take next? •A. Notify the health care provider. •B. Assess the incision for redness. •C. Reposition the left leg on pillows. D.Check the patient's blood pressure.
Answer: A - The patient's clinical manifestations suggest compartments syndrome and delay in diagnosis and treatment may lead to severe functional impairment. •Why the other options are wrong: •B & D - The data do not suggest problems with blood pressure or infection •C - Elevation of the leg will decrease arterial flow and further reduce perfusion.
The patient is taken to the emergency department with an injury to the left arm. Which intervention should the nurse perform first? A.Assess nailbeds for capillary refill time B.Remove the patient's clothing from the arm C.Call radiology for a STAT x-ray of the arm D.Prepare the patient for cast application
Answer: A. The nurse should perform a neurovascular assessment and a capillary refill is apart of that assessment. This helps determine the extent of damage to the extremity. • •Why the others are wrong: B - Clothing may need to be removed, but not before the assessment C - An X-ray will be done, but the priority is determining neurovascular damage first D - A cast may or may not be applied depending on extent of damage
Which nursing intervention will be included in the plan of care after a patient with a right femur fracture has a hip spica cast applied? •A. Avoid placing the patient in prone position. •B. Ask the patient about abdominal discomfort. •C. Discuss remaining on bed rest for several weeks. •D. Use the cast support bar to reposition the patient.
Answer: B - Assessment of bowel sounds, abdominal pain, and nausea and vomiting will detect the development of abdominal cast syndrome. •Why the other options are wrong: •A & C - After the cast dries, the patient can begin ambulating with the assistance of physical therapy personnel and may be turned to the prone position. •D - To avoid breakage, the cast support bar should not be used for repositioning
A tennis player has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included? A. "You will not be able to serve a tennis ball again." B. "You will begin pendulum exercises tomorrow." C. "Keep the shoulder immobilizer on for the first 4 day." D."The surgeon will use the drop-arm test to determine the success of surgery."
Answer: B - Pendulum exercises begin post op day 1 after a rotator cuff repair to prevent "frozen shoulder." •Why the other options are wrong: •A - The patient may be able to return to tennis after rehabilitation. •C - A shoulder immobilizer is typically utilized for 6 weeks. •D - The drop-arm test is used to test for rotator cuff injury but not after surgery.
A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which nursing assessment finding indicates a potential complication of the fracture? •A. The patient states the pelvis feels unstable. •B. Abdomen is distended and bowel sounds are absent. •C. The patient complains of pelvic pain with palpation. •D. Ecchymoses are visible across the abdomen and hips.
Answer: B - The abdominal distention and absent bowel sounds may be due to complications of pelvic fractures such as paralytic ileus or hemorrhage or trauma to the bladder, urethra, or colon. Why the other options are wrong: Pelvic instability, abdominal pain with palpation, and abdominal bruising would be expected with this type of injury.
The nurse's discharge teaching for a patient who has had a repair of a fractured mandible will include information about •A. adminicstration of nasogastric tube feedings. •B. how and when to cut the immobilizing wires. •C. the importance of high-fiber foods in the diet. •D. the use of sterile technique for dressing changes.
Answer: B - The jaw will be wired for stabilization, and the patient should know what emergency situations require the wires to be cut to protect the airway. Why the other options are wrong:A - Initially, the patient may receive nasogastric tube feedings, but by discharge, the patient will swallow liquid through a straw. C - The diet is liquid, and patients are not able to chew high-fiber foods. •D - There are no dressing changes for this procedure.
After being hospitalized for 3 days with a right femur fracture, a patient suddenly develops shortness of breath and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first? •A. Stay with the patient and offer reassurance. •B. Administer prescribed PRN O2 at 4 L/min. •C. Check the patient's legs for swelling or tenderness. •D. Notify the health care provider about the symptoms.
Answer: B - The patient's clinical manifestations and history are consistent with a pulmonary embolism, and the nurse's first action should be to ensure adequate oxygenation. Why the other options are wrong: •A - The nurse should offer reassurance to the patient, but meeting the physiologic need for O2 is a higher priority •C & D - The health care provider should be notified after the O2 is started and pulse oximetry obtained concerning suspected fat embolism or venous thromboembolism.
The nurse is preparing discharge instructions for a patient who had a total hip replacement from a hip fracture. Which of the following interventions should the nurse include? • A.Do not cross your legs longer than 30 minutes at a time B.Use an elevated toilet seat C.Limb shortening is an expected outcome D.When bathing, take tub baths only
Answer: B - it is recommended to use an elevated toilet seat because the patient cannot flex their hips more than 90 degrees. • •Why the other answers are wrong: oA - the patient should not cross their legs at all during recovery because this increases risk of dislocation oC - Limb shortening is a sign of dislocation which requires immediate intervention. This is not an expected finding oD - Tub baths are not recommended because this forces the patient to flex their hips 90 degrees or more.
The nurse is working on an orthopedic floor. Which patient should the nurse assess first after change-of-shift report? • A.The 84 y.o. female with a fractured right femoral neck in Buck's traction B.The 64 y.o. female with a left total knee replacement who has confusion C.The 88 y.o. male post-right total hip replacement with an abduction pillow D.The 50 y.o. postop patient with a continuous passive motion (CPM) device
Answer: B. Confusion is an abnormal occurrence from a total knee replacement. This patient should be seen first because confusion is a symptom of hypoxia. • •Why the other options are wrong: A - Buck's traction is normal treatment for a fracture femoral neck. C - This is a common treatment for a total hip replacement. D - this is a treatment used for total knee replacements.
The nurse is caring for a patient with a right BKA. The nurse notes there is a large amount of bright red blood on the patient's residual limb dressing. Which intervention should the nurse implement first? A.Notify the healthcare provider B.Assess the patient's blood pressure and pulse C.Reinforce the dressing with an additional dressing Check the patient's last hemoglobin and hematocrit level
Answer: B. Determining if the patient is hemorrhaging is the first intervention. Therefore, you need to assess for s/sx of hypovolemic shock, like a low BP and increased pulse. This is an ABC answer.Why the others are wrong: A - if the patient is hemorrhaging, the surgeon needs to be notified, but how do you determine hemorrhaging? C - Reinforcing the dressing can help, but you must assess first. D - Checking labs is appropriate, but would you do that first? Remember with priority, all answers are generally good. But you need to consider first assessment, safety, ABC's and least-invasive to most-invasive
The nurse instructs the patient with a left BKA to lie on their stomach for at least 30 minutes a day. The patient asks the nurse, "Why do I need to lie on my stomach?" Which statement is the most appropriate response by the nurse? A."This position will help your lungs expand better." B."Lying on your stomach will help prevent contractures." C."This will help decrease phantom pain." D."This position will take pressure off your backside."
Answer: B. The prone position helps stretch the hamstring muscles, which helps prevent flexion contractures. Flexion contractures can lead to problems fitting the patient for a prosthesis. Why the other options are wrong: A - decreases lung expansion. C - Lying on back does not affect phantom pain. D - This will help take pressure off of the patient's buttocks, but it is not why it is recommended for a patient with a lower extremity amputation.
The orthopedic trauma nurse is receiving shift report. The nurse understands that which of the following patient assignments is at highest risk of developing a fat embolism? • A.A 70-year-old male with bilateral crush injuries to their hands B.A 45-year-old female with a transverse fracture of the right iliac crest C.A 30-year-old male with a compression fracture in their C4-C5 D.A 66-year-old female with a stress fracture to their right distal and middle phalanges
Answer: B. This is a pelvic fracture. Patients with pelvic fractures are at higher risk of fat emboli. • •Why the others are wrong: o Patients at higher risk of developing fat emboli generally have fractured long bones, ribs, or pelvic bones. The other patients do not have fractures in those areas.
The patient admitted with a diagnosis of a fractured hip who is in Buck's traction is complaining of severe pain. Which intervention should the nurse implement? • A.Adjust the patient-controlled analgesic machine for a lower dose B.Ensure the weights of Buck's traction are off the floor and hanging freely C.Raise the head of the bed to 45 degrees and the foot to 15 degrees D.Turn the patient onto the affected leg using pillows to support the other leg
Answer: B. Weights from traction should be off the floor and hanging freely. Buck's traction is used to reduce muscle spasms preoperatively in patients who have fractured hips. •Why the others are wrong: A - Healthcare providers adjust PCA dosages, not nurses. Lowering the dose will also not help with pain. C - Raising the head of the bed or the foot will alter the traction. D - Turning the patient onto the affected side will worsen pain instead of relieve it
A patient arrived at the emergency department after tripping over a rug and falling at home. Which finding is most important for the nurse to communicate to the health care provider? •A. There is bruising at the shoulder area. •B. The patient reports arm and shoulder pain. •C. The right arm appears shorter than the left. •D. There is decreased shoulder range of motion.
Answer: C - A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency. Why the other options are wrong: Bruising, pain, and decreased range of motion should also be reported, but these do not indicate emergent treatment is needed to preserve function.
Which discharge instruction will the emergency department nurse include for a patient with a sprained ankle? A. Keep the ankle loosely wrapped with gauze B. Apply a heating pad to reduce muscle spasms C. Use pillows to elevate the ankle above the heart. D. Gently move the ankle through the range of motion.
Answer: C - Elevation of the leg will reduce swelling and pain. •Why the other options are wrong: •A - Compression bandages are used to decrease swelling •B - For the first 24 to 48 hours, cold packs are used to reduce swelling •D - The ankle should be rested and kept immobile to prevent further swelling or injury
The nurse is assessing a patient who is scheduled for surgical fixation of a compound fracture of the right ulna. Which of these findings should the nurse report to the healthcare provider? A.Ecchymosis around the fracture site B.Crepitus at the fracture site C.Paresthesia distal to the fracture site Diminished range of motion of the right arm
Answer: C - Paresthesia distal to the fracture site is a sign of neurovascular compromise. Remember your 6 P's when assessing fractures. • •Why the others are wrong: oA - this finding is characteristic of a fracture (contusion, Table 62-4) oB - Crepitus can occur at the fracture site. (Table 62-4) D - Diminished range of motion is expected from a fracture
A patient who slipped and fell in the shower at home has a proximal left humerus fracture immobilized with a long-arm cast and a sling. Which nursing intervention will be included in the plan of care? •A. Use surgical net dressing to hang the arm from an IV pole. •B. Immobilize the fingers of the left hand with gauze dressings. •C. Assess the left axilla and change absorbent dressings as needed. •D. Assist the patient in passive range of motion (ROM) for the right arm.
Answer: C - The axilla can become excoriated when a sling is used to support the arm, and the nurse should check the axilla and apply absorbent dressings to prevent this. Why the other options are wrong: •A - A patient with a sling would not have traction applied by hanging. •B - The patient will be encouraged to move the fingers on the injured arm to maintain function and to help decrease swelling. D - The patient will do active ROM on the uninjured side.
A patient who slipped and fell in the shower at home has a proximal left humerus fracture immobilized with a long-arm cast and a sling. Which nursing intervention will be included in the plan of care? •A. Use surgical net dressing to hang the arm from an IV pole. •B. Immobilize the fingers of the left hand with gauze dressings. •C. Assess the left axilla and change absorbent dressings as needed. •D. Assist the patient in passive range of motion (ROM) for the right arm.
Answer: C - The axilla can become excoriated when a sling is used to support the arm, and the nurse should check the axilla and apply absorbent dressings to prevent this. Why the other options are wrong: •A - A patient with a sling would not have traction applied by hanging. •B - The patient will be encouraged to move the fingers on the injured arm to maintain function and to help decrease swelling. •D - The patient will do active ROM on the uninjured side.
A high school teacher with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for arthroplasty of several joints in the left hand. Which patient statement to the nurse indicates a realistic expectation for the surgery? A. "This procedure will correct the deformities in my fingers." B. "I will not have to do as many hand exercises after the surgery." C. "I will be able to use my fingers with more flexibility to grasp things." D. "My fingers will appear more normal in size and shape after this surgery."
Answer: C - The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process. Why the other options are wrong: A & D - The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process. B - Hand exercises will be prescribed after the surgery.
After a motorcycle accident, a patient arrives in the emergency department with severe swelling of the left lower leg. Which action will the nurse take first? •A. Elevate the leg on 2 pillows. •B. Apply a compression bandage. •C. Assess leg pulses and sensation. •D. Place ice packs on the lower leg.
Answer: C - The initial action by the nurse will be to assess circulation to the leg and observe for any evidence of injury such as fractures or dislocations. Why the other options are wrong: After the initial assessment, the other actions may be appropriate based on what is observed during the assessment.
The nurse is caring for a patient with a fractured left tibia and fibula. Which data should the nurse report to the health-care provider immediately? A.Localized edema and discoloration developing hours after the injury B.Generalized weakness and increased sensitivity to touch C.Dorsalis pedal pulse cannot be located with a Doppler and increasing pain Pain relieved after taking four (4) mg of hydromorphone (Dilaudid)
Answer: C - if the pulse cannot be palpated or detected with a Doppler with the increasing pain, this needs to be reported immediately because the patient is experiencing neurovascular compromise (compartment syndrome). • •Why the others are wrong: A - localized edema and discoloration a few hours after injury are expected. B - Generalized weakness and sensitivity to touch are common and not life threatening. D - Pain management is a desired outcome.
The post-anesthesia care unit (PACU) nurse is caring for a patient who just had a right BKA. Which intervention should the nurse implement? A.Assess the surgical dressing every 2 hours B.Do not allow the patient to see their stump C.Keep a large tourniquet at the patient's bedside D.Perform passive range-of-motion exercises to the left leg
Answer: C. This is an ABC question because the patient is at risk for hemorrhaging, either internally or externally. Why the other options are wrong: A - the patient is in PACU and the dressing needs to be assessed more frequently than every 2 hours B - the patient must come to terms with their amputation. You should encourage them to look at their residual limb. D - the nurse should encourage active, not passive, range of motion exercises
The nurse is providing discharge teaching to the patient who fractured their right humerus. Which information should the nurse include regarding cast care? A.Keep the fractured arm at heart level B.Use a wire hanger to scratch the inside of the cast C.Use a hair dryer on the cool setting for any itchy areas D.Explain that foul smells are expected occurrences
Answer: C. Using a hair dryer on the cool setting can help relieve itching. •Why the other options are wrong: A - the arm should be elevated above heart level, not at it or below it. B - The nurse should instruct the patient to never insert anything in the cast. Doing so can break the skin and cause infection. D - Smells indicate infection and need to be reported to the HCP.
The day after a 60-yr-old patient has open reduction and internal fixation (ORIF) for an open, displaced tibial fracture, the nurse identifies the priority nursing diagnosis as •A. Activity intolerance related to deconditioning. •B. risk for constipation related to prolonged bed rest. •C. risk for impaired skin integrity related to immobility. D.Risk for infection related to disruption of skin integrity.
Answer: D - A patient having ORIF is at risk for problems such as wound infection and osteomyelitis. Why the other options are wrong: After ORIF, patients typically are mobilized starting the first postoperative day, so the other problems caused by immobility are not as likely.
A nurse is caring for a client who has an unrepaired femur fracture of the midshaft. Which of the following techniques should the nurse use when performing an assessment of the client's neurovascular status? A.Measure the circumference of the thigh B.Palpate the femoral pulse C.Monitor the patient's calf for edema Instruct the patient to wiggle his toes
Answer: D - The nurse should observe the client's ability to move his toes when collecting data regarding neurovascular status distal to the fracture. Other means of evaluating neurovascular status include assessing skin color and temperature, sensation, pain, and capillary refill. •Why the other options are wrong: A - Measuring the circumference of the thighs and comparing the injured to the unaffected is a way to assess for internal bleeding. While this helps assess for internal bleeding and shock, it does not help assess neurovascular status. B - Palpating the pulse above the injury site does not effectively determine neurovascular status. C - The nurse should monitor the client's calf for edema, warmth, tenderness, and redness as they are indications of deep-vein thrombosis. However, monitoring calf edema does not assess neurovascular
A factory line worker has repetitive strain syndrome in the left elbow. The nurse will plan to teach the patient about A. surgical options. B. elbow injections. C. wearing a left wrist splint. D. modifying arm movements.
Answer: D - Treatment for repetitive strain syndrome includes changing the ergonomics of the activity. •Why the other options are wrong: •A & B - Elbow injections and surgery are not initial options for this type of injury. •C - A wrist splint might be used for hand or wrist pain.
The nurse is caring for a patient in a short leg cast with an oblique fracture to their right fibula from a motor vehicle accident. Six hours after cast application, the patient complains of tingling in their right foot. Which action should the nurse take first? A.Call the healthcare provider B.Apply an ice pack to the right leg C.Elevate the right leg D.Assess the temperature of the foot
Answer: D - You want to perform a neurovascular assessment first to determine extent of damage. Paresthesia is one of the six P's of compartment syndrome. Why are the other options wrong: A - Calling the healthcare provider is the correct option, but you would not do this before a neurovascular assessment. B - Cold compresses will worsen compartment syndrome, not help. This is inappropriate C - Elevating the extremity with suspected compartment syndrome will cause worsened ischemia. This is inappropriate.
The emergency room nurse is receiving a patient who was in a motor vehicle accident. The patient arrives in the ER with multiple contusions to the face and neck from the air bag deployment. Which intervention is the nurse's priority? • A.Obtain an X-Ray of the head and neck B.Initiate IV access C.Obtain a 12-lead EKG Stabilize the cervical spine
Answer: D - it is important to stabilize the cervical spine to protect it from any further neurovascular damage. This is also to protect the airway. • •Why the others are wrong: oWhile all of the other interventions are reasonable and warranted, stabilizing the cervical spine is the priority. This is for safety and ABCs. It is also least invasive to most invasive.
The following describe what injury? •Noncontact injury: twisting and hearing a "pop", pain and swelling •Positive Lachman's test: Flex the knee 15 to 30 degrees and pull the tibia forward while femur is stabilized; the forward motion of the tibia occurs with the feeling of a soft or indistinct endpoint
Anterior Cruciate Ligament (ACL)
A nurse is caring for a 3-year-old client who has suffered an arm fracture. The arm has been cast in a plaster cast and the nurse is providing discharge teaching to the family. Which information should the nurse include as part of teaching? A. Even if the cast is wrapped in plastic and kept out of the water, do not take a bath B. Cover rough edges of the cast with a cloth tape C. Keep the arm below the level of the heart to prevent swelling D. Remove small parts of the padding of the cast to assess the circulation of the fingers
B. Cover rough edges of the cast with a cloth tape
A client is about to start therapy with methotrexate for rheumatoid arthritis. Knowing the adverse effects of methotrexate, you advise the client to watch for which of the following? A. Dysphasia B. Sore Throat C. Edema D. Paresthesia
B. Sore Throat Methotrexate may cause bone marrow suppression. The client should report any sign of infection, such as a sore throat or fever. Dysphagia, edema, and paresthesia (numbness or tingling sensations on the skin) are not common adverse effects of methotrexate. Adverse effects of this drug include headache, mucositis, gastric ulcers, gingivitis, and hepatotoxicity.
A primary care provider prescribes etanercept to treat a client's rheumatoid arthritis. Prior to beginning the treatment, the client requires testing for which of the following? A. Pancreatitis B. Hepatitis C. Tuberculosis D. Gastritis
C. Tuberculosis Primary care providers should test clients for tuberculosis prior to treatment with etanercept. Pulmonary tuberculosis in clients taking etanercept can spread to other organs and pose treatment challenges. They should also monitor clients for the development of tuberculosis during etanercept therapy
The primary care provider prescribes calcitonin-salmon (Miacalcin) for a post-menopausal client. Knowing the adverse effects of calcitonin, you should instruct the client to do which of the following? A. increase fluid intake. B. rise slowly from a reclining position. C. increase calcium and vitamin D intake. D. rest painful joints after exercise
C. increase calcium and vitamin D intake. Calcitonin can cause hypocalcemia due to increased excretion of calcium. The client should increase calcium and vitamin D intake and watch for indications of hypocalcemia, such as muscle cramps and numbness in the fingers or toes. Increasing fluid intake will not prevent adverse effects; in fact, the human form of calcitonin can worsen one of its adverse effects: urinary frequency. Calcitonin does not cause orthostatic hypotension, although it can cause weakness and shortness of breath. Calcitonin is more likely to cause headache than joint pain.
A nurse is preparing to care for a client who is in balanced skeletal traction to stabilize a femur fracture. Which of the following actions should the nurse include in the client's plan of care? A. Offering the client a diet high in fluid and fiber B. Encouraging active range of motion of the affected leg C. Removing the weights prior to repositioning the client D. Inspecting pin sites every 24 hr for drainage
Correct Answer: A. Offering the client a diet high in fluid and fiber A client who is immobile is at risk of constipation. The nurse should encourage a diet high in fluid and fiber to promote gastrointestinal function.
A client who is menopausal is taking a calcium supplement to prevent osteoporosis. You instruct the client to watch for which of the following indications of hypercalcemia? A. Eye twitching B. Bleeding gums C. Tinnitus D. Nausea
D. Nausea Manifestations of hypercalcemia include anorexia, nausea, vomiting, and constipation. Hypocalcemia can cause twitching, tetany, and muscle spasms. Vitamin C deficiency can cause bleeding gums and gingivitis.
The following describes what injury? •Shoulder weakness, pain, decreased ROM Positive drop arm test: Arm abducted to 90 degrees, Pt asked to slowly lower arm, arm falls suddenly
Rotator Cuff Injury
A client 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 skin that is shiny and growing more hair in the injured extremity. The nurse should anticipate providing care for what complication? a) Complex regional pain syndrome b) Avascular necrosis of bone c) Heterotrophic ossification d) Reaction to an internal fixation device
a) Complex regional pain syndrome The symptoms reported by the client are consistent with complex regional pain syndrome. Avascular necrosis is manifested by pain and limited movement. Pain and decreased function are the prime indicators of reaction to an internal fixation device. Heterotrophic ossification causes muscular pain and limited muscular contraction and movement.
Colles fracture occurs in which area? a) Distal radius b) Clavicle c) Elbow d) Humeral shaft
a) 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 nurse notes that the client's left great toe deviates laterally. This finding would be recognized as which condition? a) Hallux valgus b) Hammertoe c) Pes cavus d) Flatfoot
a) Hallux valgus Hallux valgus is commonly referred to as a bunion. Hammertoes are usually pulled upward. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. The client with flatfoot demonstrates a diminished longitudinal arch of the foot.
Which factor may contribute to compartment syndrome? a) Hemorrhage b) Macular lesion c) Disuse syndrome d) Venous thromboembolus
a) Hemorrhage The normal pressure of a compartment can be altered in cases of fracture by the force of the injury itself or by development of edema or hemorrhage at the site of the injury. Venous thromboemboli are another early complication of fracture, but they are not related to compartment syndrome. Macular lesion is caused by the accumulation of blood under the skin, as occurs with trauma such as bone fracture. Disuse syndrome mostly occurs in hip fracture.
Which condition is a metabolic bone disease characterized by inadequate mineralization of bone? a) Osteomalacia b) Osteomyelitis c) Osteoporosis d) Osteoarthritis
a) Osteomalacia Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from extension of soft-tissue infection, direct bone contamination, or hematogenous spread. Osteoarthritis (OA), also known as degenerative joint disease, is the most common and frequently disabling of the joint disorders. OA affects the articular cartilage, subchondral bone, and synovium.
The emergency department nurse teaches clients with sports injuries to remember the acronym PRICE. This acronym stands for which combination of treatments? a) Protection, rest, ice, compression, elevation b) Pressure, rotation, ice, compression, examination c) Protection, rest, ice, circulation, examination d) Pressure, rotation, immersion, compression, elevation
a) Protection, rest, ice, compression, elevation PRICE is used to treat contusions, sprains, and strains. While circulation problems must be examined, the PRICE treatment does not refer to circulation and examination. Rotation of a joint is contraindicated when injury is suspected, and immersion of the area may be anatomically difficult. Rotation of a joint is contraindicated when injury is suspected, and examination, while indicated, does not provide treatment.
With fractures of the femoral neck, the leg is a) shortened, adducted, and externally rotated. b) shortened, abducted, and internally rotated. c) abducted and externally rotated. d) adducted and internally rotated.
a) shortened, adducted, and externally rotated. With fractures of the femoral neck, the leg is shortened, adducted, and externally rotated.
Which term refers to an injury to ligaments and other soft tissues surrounding a joint? a) Strain b) Subluxation c) Sprain d) Dislocation
c) 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.
Which common problem of the upper extremity results from entrapment of the median nerve at the wrist? a) Dupuytren's contracture b) Carpal tunnel syndrome c) Ganglion d) mpingement syndrome
b) Carpal tunnel syndrome Carpal tunnel syndrome is commonly due to repetitive hand activities. A ganglion is a collection of gelatinous material near the tendon sheaths and joints that appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. Dupuytren contracture is a slowly progressive contracture of the palmar fascia. Impingement syndrome is associated with the shoulder and may progress to a rotator cuff tear.
An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? a) Impacted b) Comminuted c) Compound d) Depressed
b) 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? a) Ganglion cysts b) Compartment syndrome c) Gastrointestinal bleeding d) Carpal tunnel syndrome
b) 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.
Which term refers to a blunt force injury to soft tissue? a) Dislocation b) Contusion c) Fracture d) Strain
b) Contusion A contusion is blunt force injury to soft tissue. A dislocation is a separation of joint surfaces. A strain is a musculotendinous injury. A fracture is a break in the continuity of the bone.
Which term refers to a break in the continuity of a bone? a) Subluxation b) Fracture c) Malunion d) Dislocation
b) 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.
Which type of fracture occurs when a bone fragment is driven into another bone fragment? a) Transverse b) Impacted c) Oblique d) Spiral
b) 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.
Which term refers to a disease of a nerve root? a) Involucrum b) Radiculopathy c) Contracture d) Sequestrum
b) Radiculopathy When the client reports radiating pain down the leg, the client is describing radiculopathy. Involucrum refers to new bone growth around the sequestrum. Sequestrum refers to dead bone in an abscess cavity. Contracture refers to abnormal shortening of muscle or fibrosis of joint structures.
A fracture is considered pathologic when it a) results in a fragment of bone being pulled away by a ligament or tendon and its attachment. b) occurs through an area of diseased bone. c) presents as one side of the bone being broken and the other side being bent. d) involves damage to the skin or mucous membranes.
b) 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.
When is it advisable for the nurse to apply heat to a sprain or a contusion? a) Only after a week b) Immediately c) After 2 days d) Do not apply at all
c) 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.
Which type of fracture is one in which the skin or mucous membrane extends to the fractured bone? a) Incomplete b) Simple c) Compound d) Complete
c) 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.
The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication? a) Hypovolemic shock b) Compartment syndrome c) Fat embolism syndrome d) Reflex sympathetic dystrophy syndrome
c) 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.
Which is a hallmark sign of compartment syndrome? a) Motor weakness b) Edema c) Pain d) Weeping skin surfaces
c) Pain A hallmark sign of compartment syndrome is pain that occurs or intensifies with passive range of motion.
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) avascular necrosis of bone. c) complex regional pain syndrome. d) a reaction to an internal fixation device.
c) complex regional pain syndrome. Complex regional pain syndrome is frequently chronic and occurs most often in women. Avascular necrosis is manifested by pain and limited movement. Pain and decreased function are the prime indicators of reaction to an internal fixation device. Heterotrophic ossification causes muscular pain and limited muscular contraction and movement.
Which is one of the most common causes of death in clients diagnosed with fat emboli syndrome? a) Myocardial infarction b) Pulmonary embolism c) Stroke d) Acute respiratory distress syndrome
d) Acute respiratory distress syndrome Acute pulmonary edema and acute respiratory distress syndrome are the most common causes of death.
An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? a) Impacted b) Depressed c) Compound d) Comminuted
d) 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.
Which term refers to a fracture in which one side of a bone is broken and the other side is bent? a) Oblique b) Avulsion c) Spiral d) Greenstick
d) Greenstick 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 when a fragment of bone has been pulled away by a ligament or tendon and its attachment. An oblique is a fracture occurring at an angle across the bone.
Which should be included in the teaching plan for a client diagnosed with plantar fasciitis? a) The pain of plantar fasciitis diminishes with warm water soaks. b) Plantar fasciitis presents as acute-onset pain localized to the ball of the foot that occurs when pressure is placed on it and diminishes when pressure is released. c) Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion. d) Management of plantar fasciitis includes stretching exercises.
d) Management of plantar fasciitis includes stretching exercises. Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices (e.g., heel cups, arch supports), and the use of nonsteroidal antiinflammatory drugs. Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as acute-onset heel pain experienced upon taking the first steps in the morning. The pain is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs.
Which term refers to the failure of fragments of a fractured bone to heal together? a) Subluxation b) Malunion c) Dislocation d) Nonunion
d) 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.
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? a) Osteomalacia b) Osteomyelitis c) Osteoporosis d) Osteitis deformans
d) Osteitis deformans Osteitis deformans (Paget disease) results in bone that is highly vascularized and structurally weak, predisposing to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from the extension of a soft-tissue infection, direct bone contamination, or hematogenous spread.
Morton neuroma is exhibited by which clinical manifestation? a) High arm and a fixed equinus deformity b) Longitudinal arch of the foot is diminished c) Inflammation of the foot-supporting fascia d) Swelling of the third (lateral) branch of the median plantar nerve
d) Swelling of the third (lateral) branch of the median plantar nerve. Morton neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia.
Instructions for the client with low back pain include that, when lifting, the client should a) use a narrow base of support. b) place the load away from the body. c) bend the knees and loosen the abdominal muscles. d) avoid overreaching.
d) avoid overreaching. Instructions for the client with low back pain should include that, when lifting, the client should avoid overreaching. The client should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back.
An x-ray demonstrates a fracture in which the fragments of bone are driven inward. This type of fracture is referred to as a) comminuted. b) impacted. c) compound. d) depressed.
d) 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 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. a) Skin breakdown b) Pneumonia c) Necrosis of the humerus d) Sepsis e) Delirium
e) Delirium, b) Pneumonia, d) Sepsis, a) Skin breakdown 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.
Which interventions should be included in the discharge teaching for a patient who had a total hip replacement? Select all that apply. A.Discuss the patient's weight-bearing limits B.Request the patient demonstrate use of assistive devices C.Explain importance of increasing activity gradually D.Instruct patient not to take medication prior to ambulating E.Tell the patient to ambulate with open-toed house shoes
•Answers: A, B, C A - Patients need to understanding their weight bearing limit to prevent injury B - Proper demonstration of assistive devices is necessary, so the patient knows how to use them safely to prevent injury C - Increase in activity should occur slowly to prevent complications •Why the others are wrong: D - using medication therapy, including analgesics, anti-inflammatory, and/or muscle relaxants, should be taught so the patient is comfortable while ambulating E - The patient should ambulate in well fitted, supported, closed toe shoes such as walking shoes or tennis shoes
A nurse is providing post-procedural teaching to a client who had a diagnostic knee arthroscopy. Which of the following statements indicates that the client understands the nurse's instructions? A. "I'll take aspirin to relieve my pain." B. "I'll keep my leg elevated for the first day." C. "I'll put a heating pad on my knee for the first day." D. "I'll resume my usual activities as soon as I leave."
✔ B. "I'll keep my leg elevated for the first day." Following a diagnostic arthroscopy, the client should keep the leg elevated for 12 to 24 hours to help reduce pain and swelling.
A nurse is teaching a client with arthritis who is experiencing joint pain that impairs mobility. Which of the following instructions should the nurse include? A. "Engage your joints in resistance exercises." B. "Avoid using assistive devices when walking." C. "Perform passive exercises." D. "Apply heat to your joints prior to exercising."
✔D. "Apply heat to your joints prior to exercising." The nurse should instruct the client to apply heat to the joints prior to exercising to increase mobility and reduce pain.
