Hip Fracture, *Bucks Traction* Questions

The nurse has given a client instructions about crutch safety. Which client statement indicates that the client understands the instructions? Select all that apply. 1. "I should not use someone else's crutches." 2. "I need to remove any scatter rugs at home." 3. "I can use crutch tips even when they are wet." 4. "I need to have spare crutches and tips available." 5. "When I'm using the crutches my arms need to be completely straight."

1. "I should not use someone else's crutches." 2. "I need to remove any scatter rugs at home." 4. "I need to have spare crutches and tips available."

A client who has been taking high doses of acetylsalicylic acid (ASA, or aspirin) to relieve pain from osteoarthritis now has more generalized joint pain and an elevated temperature. The nurse should assess for which complication to determine whether the client has other signs of aspirin toxicity? 1. Diarrhea 2. Constipation 3. Double vision 4. Ringing in the ears

4. Ringing in the ears SE: (tinnitus)

A home care nurse has instructed a client how to perform the three-point gait with the use of crutches. The nurse observes the client using this gait to ensure correct performance of the maneuvers. Which observation, if made by the nurse, would indicate that the client understands how to perform this type of gait? 1. The client moves both crutches forward and then swings both feet forward to the crutches. 2. The client moves both crutches forward, along with the affected leg, and then moves the unaffected leg forward. 3. The client moves the right crutch forward, along with the left foot, and then brings the right foot and the left crutch forward. 4. The client moves the left crutch forward, along with the right foot, and then brings the left foot and the right crutch forward.

2. The client moves both crutches forward, along with the affected leg, and then moves the unaffected leg forward.

. An older client admitted to the hospital with a hip fracture is placed in Buck's extension traction. The nurse plans to frequently monitor which specimen item? a) temperature b) mental state c) neurovascular status d) range of motion ability

c) neurovascular status - The neurovascular status of the extremity of the client in Buck's extension traction must be assessed frequently. Older clients are especially at risk for neurovascular compromise because many older clients already have disorders that affect the peripheral vascular system. Although the client's temperature is monitored, it is not specific to the use of Buck's extension traction. Although clients in some types of traction do become depressed after a few days or weeks, Buck's extension traction is usually used preoperatively, which typically involves a few hours or 1 to 2 days, at the most. Range of motion of the involved leg is contraindicated in hip fractures.

The nurse has delegated the ambulation of a client to the unlicensed assistive personnel (UAP). Which actions by the UAP support a clear understanding of the appropriate steps to carry out this task safely? Select all that apply. 1. Remove clutter that may interfere with ambulation. 2. Assist client in applying nonskid shoes before ambulation. 3. Instruct client to sit up on the bedside and dangle before ambulation. 4. Understand that the client may experience nausea as a normal expectation during ambulation. 5. Observe the client for dizziness during ambulation and report immediately.

1. Remove clutter that may interfere with ambulation. 2. Assist client in applying nonskid shoes before ambulation. 3. Instruct client to sit up on the bedside and dangle before ambulation. 5. Observe the client for dizziness during ambulation and report immediately.

A patient had hip surgery. On the second post-op day, the patient is agitated, is tremulous and confused. What should the nurse primarily assess? a) the surgical wound b) alcohol use before surgery c) peripheral circulation d) breathing pattern

b) alcohol use before surgery - the client's sign and symptoms indicate alcohol withdrawal.

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse responds knowing that which would most likely result from this improper crutch measurement? 1. A fall and further injury 2. Injury to the brachial plexus nerves 3. Skin breakdown in the area of the axilla 4. Impaired range of motion while the client ambulates

2. Injury to the brachial plexus nerves

The nurse has completed giving discharge instructions to a client after total knee replacement with a metal prosthesis. The nurse determines that the client needs additional instructions if the client makes which statement? 1. Report bleeding gums or tarry stools. 2. Report fever, redness, or increased pain. 3. Expect changes in the shape of the knee. 4. Tell future caregivers about the metal implant.

3. Expect changes in the shape of the knee

How do you position a client with left hip fracture in Buck's traction? a) head of bed raised at 45 degree angle b) left calf on pillow from knee to ankle c) position the left on affected side with pillows between legs d) position the left in the center of the bed with the leg extended

b) left calf on pillow from knee to ankle - elevate the leg with pillow to relieve pressure from the heel of the foot and to improve the effectiveness of the countertraction.

The nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding? 1. Inflammation 2. Serous drainage 3. Pain at a pin site 4. Purulent drainage

2. Serous drainage

A client is complaining of knee pain. The knee is swollen, reddened, and warm to the touch. The nurse interprets that the client's signs and symptoms are compatible with which conditions? Select all that apply. 1. Infection 2. Recent injury 3. Inflammation 4. Degenerative disease 5. Developmental retardation

1. Infection 2. Recent injury 3. Inflammation

A nurse has provided discharge instructions to a client after a total hip replacement. Which statement by the client indicates a need for further instruction? 1. "I should sit in my recliner when I get home." 2. "I need to keep my legs apart while sitting or lying." 3. "I should try to obtain an elevated toilet seat for use at home." 4. "I should contact the health care provider (HCP) if the incision becomes red or irritated or if I note any drainage."

1. "I should sit in my recliner when I get home."

A nurse has provided instructions to a client with a diagnosis of rheumatoid arthritis about measures to protect the joints. Which statement by the client indicates a need for further instruction? 1. "Pain or fatigue is expected, and I should try to continue with the activity if this occurs." 2. "I should use large joints instead of small joints when performing activities." 3. "I should try not to remain in the same position for a long period of time." 4. "I should slide objects rather than lifting them."

1. "Pain or fatigue is expected, and I should try to continue with the activity if this occurs."

A client with a hip fracture asks the nurse why Buck's (extension) traction is being applied before surgery. The nurse provides a response based on which purpose of Buck's (extension) traction? 1. Allows bony healing to begin before surgery 2. Provides rigid immobilization of the fracture site 3. Lengthens the fractured leg to prevent severing of blood vessels 4. Provides comfort by reducing muscle spasms and provides fracture immobilization

4. Provides comfort by reducing muscle spasms and provides fracture immobilization

The nurse is preparing to teach a client how to safely use crutches. Before initiating the teaching, the nurse performs an assessment on the client. The priority nursing assessment should include which information? 1. The client's fear related to the use of crutches 2. The client's feelings about the restricted mobility 3. The client's understanding of the need for increased mobility 4. The client's vital signs, muscle strength, and previous activity level

4. The client's vital signs, muscle strength, and previous activity level

A home care nurse is providing instructions to a client regarding the use of crutches. The client asks the nurse to demonstrate the method for going down the stairs with the crutches. How should the nurse accurately demonstrate this technique? 1. Crutches and the affected leg down, followed by the unaffected leg 2. Crutches and the unaffected leg down, followed by the affected leg 3. Unaffected leg down first, followed by the crutches and the affected leg 4. Affected leg down first, followed by the crutches and the unaffected leg

1. Crutches and the affected leg down, followed by the unaffected leg

The nurse has reviewed activity restrictions with a client who is being discharged after insertion of a femoral head prosthesis. What statement by the client will help the nurse determine that the client understands the material presented? 1. Use a raised toilet seat. 2. Bend carefully to put on socks and shoes. 3. Sit in chairs without arms for better mobility. 4. Exercise the leg past the point of 90-degree flexion.

1. Use a raised toilet seat.

The nurse is repositioning a client who has been returned to the nursing unit after internal fixation of a fractured right hip with a femoral head replacement. The nurse should use which method? 1. A trochanter roll to prevent abduction during turning 2. A pillow to keep the right leg abducted during turning 3. A pillow to keep the right leg adducted during turning 4. A trochanter roll to prevent external rotation during turning

2. A pillow to keep the right leg abducted during turning

A client has had surgery to repair a fractured left hip. When repositioning the client from side to side in the bed, what should the nurse plan to use as the most important item for this maneuver? 1. Bed pillow 2. Abductor splint 3. Adductor splint 4. Overhead trapeze

2. Abductor splint

The nurse is assigned to care for a client in traction. The nurse prepares a plan of care for the client and includes which nursing action in the plan? 1. Ensure that the knots are at the pulleys. 2. Check the weights to ensure that they are off of the floor. 3. Ensure that the head of the bed is kept at a 45- to 90-degree angle. 4. Monitor the weights to ensure that they are resting on a firm surface.

2. Check the weights to ensure that they are off of the floor

The nurse is preparing a plan of care for a client in skin traction. The nurse should monitor for which priority finding in this client? 1. Urinary incontinence 2. Signs of skin breakdown 3. The presence of bowel sounds 4. Signs of infection around the pin sites

2. Signs of skin breakdown

The nurse is developing a plan of care for a client in Buck's traction. The plan of care should include assessing the client for which finding indicating a complication associated with the use of this type of traction? 1. Hypotension 2. Weak pedal pulses 3. Redness at the pin sites 4. Drainage at the pin sites

2. Weak pedal pulses

The nurse has completed giving discharge instructions to a client who has had total knee replacement (TKR) with a metal prosthesis. The nurse determines that the client understands the instructions if the client verbalizes which statement? 1. Fever, redness, or increased pain is expected. 2. Changes in the shape of the knee are expected. 3. Other caregivers should be told about the metal implant. 4. Bleeding gums or black stools may occur, but this is normal. 3. Other caregivers should be told about the metal implant.

3. Other caregivers should be told about the metal implant

A client has been placed in Buck's extension traction. The nurse can provide for countertraction to reduce shear and friction by performing which action? 1. Using a footboard 2. Providing an overhead trapeze 3. Slightly elevating the foot of the bed 4. Slightly elevating the head of the bed

3. Slightly elevating the foot of the bed

Post-surgical nursing assessment after hip replacement should be principally concerned with the risk of neurovascular complications and the development of infection. A temperature of 101.8 F (38.7 C) postoperatively is higher than the low grade that is to be expected and should raise concern. Some pain during repositioning and following physical therapy is to be expected and can be managed with analgesics. A small amount of bloody drainage on the surgical dressing is a result of normal healing. The nurse has given instructions to a client returning home after knee arthroscopy. Which statement by the client indicates that the instructions are understood? 1. "I can resume regular exercise tomorrow." 2. "I can't eat food for the remainder of the day." 3. "I need to stay off the leg entirely for the rest of the day." 4. "I need to report a fever or site inflammation to my health care provider."

4. "I need to report a fever or site inflammation to my health care provider."

A client with rheumatoid arthritis exhibits bilateral deformities of the joints of the fingers. The nurse planning care for the client understands that these changes are most likely the result of which cause of inflammation? 1. Allergic 2. Metabolic 3. Endocrine 4. Autoimmune

4. Autoimmune

The nurse is teaching a client how to stand on crutches. The nurse tells the client to place the crutches: a) 3 inches to the front and side of the toes b) 8 inches to the front and side of the toes c) 15 inches to the front and side of the toes d) 20 inches to the front and side of the toes

B) 8 inches to the front and side of the toes - The classic tripod position is taught to the client before instructions regarding gait are given. The crutches are placed anywhere from 6 to 10 inches in front of and to the side of the client's toes, depending on the client's body size. This provides a wide enough base of support for the client and improves balance.

A nurse is caring for a patient who has had hip replacement. The nurse should be most concerned about which of the following findings? A. Complaints of pain during repositioning. B. Scant bloody discharge on the surgical dressing. C. Complaints of pain following physical therapy. D. Temperature of 101.8 F (38.7 C).

D. Temperature of 101.8 F (38.7 C). Post-surgical nursing assessment after hip replacement should be principally concerned with the risk of neurovascular complications and the development of infection. A temperature of 101.8 F (38.7 C) postoperatively is higher than the low grade that is to be expected and should raise concern. Some pain during repositioning and following physical therapy is to be expected and can be managed with analgesics. A small amount of bloody drainage on the surgical dressing is a result of normal healing.

. A client has Buck's extension traction applied to the right leg. The nurse plans which of the following interventions to prevent complications from the device? a) provide pin care once a shift b) massage the skin of the right leg with lotion every 8 hours c) inspect the skin on the right leg at least once every 8 hours d) release the weights on the right leg for range of motion exercises daily

c) inspect the skin on the right leg at least once every 8 hours Buck's extension traction is a type of skin traction. The nurse inspects the skin of the limb in traction at least once every 8 hours for irritation or inflammation. Massaging the skin with lotion is not indicated. The nurse never releases the weights of traction unless specifically ordered by the physician. There are no pins to care for with skin traction.

The nurse is caring for a client who was just admitted to the hospital with a diagnosis of a fractured right hip sustained from a fall 5 hours earlier. The nurse develops a plan of care for the client and includes interventions related to monitoring for signs of fat embolism. Which findings should be listed in the care plan as a sign/symptom of fat embolism? 1. Dyspnea and chest pain 2. Fever and chills 3. External rotation of the right leg 4. Pallor, paresthesia, and pulselessness of the right lower leg

1. Dyspnea and chest pain

. Buck's extension traction is applied to an older client following a hip fracture. The nurse explains to the client that this type of traction is: a) traction involving the use of a cast b) skeletal traction involving the use of surgically inserted pins c) circumferential traction involving the use of a belt around the body d) skin traction involving the use of traction attached to the skin and soft tissues

d) skin traction involving the use of traction attached to the skin and soft tissues - Buck's extension traction is a form of skin traction and involves the use of a belt or boot that is attached to the skin and soft tissues. The purpose of this type of traction is to decrease painful muscle spasms that accompany fractures. The weight that is used as a pulling force is limited (usually 5 to 10 pounds) to prevent injury to the skin. Options A, B, and C are incorrect descriptions.