Hip Fracture (Hip fx)

The nurse is presenting a program at a senior center on how to survive a fall. Which statement by a program participant indicates that this person needs clarification about what emergency actions to take after a fall? A) "I should crawl to a phone on the affected side to keep it stable against a hard surface." B) "I should try to cover myself with a blanket while I wait for help to arrive." C) "To call for help, I can scoot on my bottom to a low wall-mounted phone." D) "If possible, I can crawl to a stairway and use the stairs to lift up a standing position."

A) "I should crawl to a phone on the affected side to keep it stable against a hard surface." Rationale: Clients at risk for falls and hip fractures should be taught how to notify emergency services in the event of a fall and injury. These clients should be instructed to turn onto the stomach and crawl to the phone, or to scoot to the phone using the buttocks on the uninjured side. And another option is to crawl to a stairway and use the stairs to gradually lift the body to a standing position. While waiting for help to arrive, clients should cover themselves with a blanket if possible to help prevent shock.

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

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

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

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

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

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

The nurse is assessing an older adult client in a long-term care facility after a fall. Which finding requires priority action? A) The injured leg is shortened and externally rotated B) Redness and severe swelling are found at the hip joint C) Pain is relieved by moving the affected extremity D) The client is repeatedly flexing the injured leg at the hip

A) The injured leg is shortened and externally rotated Rationale: The client with a fractured hip is often in extreme pain and assumes a position with the leg on the affected side shortened and externally rotated because of gravity and the pull of the muscles. Any movement of the leg on the side of the affected hip is likely to cause severe muscle spasms and further pain. Redness and swelling are the classic signs of inflammation not immediately present after hip fracture. Extreme pain associated with hip fracture prevents any voluntary movement in the leg.

The nurse is providing discharge instructions to an older adult client who is recovering from a fractured hip. The client is planning to stay with an adult child, who is included in the discharge teaching? Which statements on the part of the client indicate appropriate understanding of the information presented by the nurse? SATA A) "I have a signed contract with Lifeline." B) "We are removing the area rugs in the hallway." C) "I've borrowed a toilet seat riser from the equipment closet." D) "I will be sure to take oxycodone before I go downstairs in the morning." E) "I can help with housework while I'm staying at my child's house."

A, B, C Rationale: Statements regarding the use of an emergency alert service and a toilet seat riser indicate appropriate understanding of the information presented. Picking up loose area rugs can help decrease the risk of falls. Pain medication should not be taken when there is a risk of a fall, particularly prior to going down a set of stairs. The nurse should assess the housework that the client wants to help with while living with the adult child. Many housework tasks will be inappropriate.

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

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

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

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

The nurse gives discharge instructions to an adult client who sustained a bicycle fall and underwent open reduction and internal fixation of a fractured hip. After the teaching is complete, which statements by the client indicate an appropriate understanding of the information presented? SATA A) "I will use my abduction pillow while sleeping to maintain proper hip alignment." B) "I will use a high toilet seat to prevent excess flexion of my hip." C) "I only need to use my walker during physical therapy appointments." D) "I will take my prescribed ibuprofen to decrease the risk for DVT E) "I might experience bruising because of the warfarin I've been prescribed."

A, B, E Rationale: Statements regarding use of an abduction pillow to maintain proper hip alignment; use of a high toilet seat to prevent excess flexion of the hip; and awareness that warfarin presents an increased risk for bruising all indicate client adequate understanding. The nurse should remind the client to use the walker at all times until told otherwise. The nurse should also explain that warfarin, not ibuprofen, is prescribed to decrease the risk for deep vein thrombosis

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

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

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

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

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

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

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

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

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

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

A postmenopausal client asks the nurse what she can do to prevent fracturing her hips, as her mother and grandmother both experienced this health problem. Which response by the nurse is most appropriate? A) "You should avoid all types of exercise." B) "You should consider a smoking cessation program." C) "You should limit your exposure to the sun." D) "You should use throw rugs throughout your home."

B) "You should consider a smoking cessation program." Rationale: One modifiable risk factor for hip fractures is smoking. Women who smoke have a greater risk of fracture because smoking reduces bone density in menopausal and postmenopausal women. The client should not be instructed to avoid exercise; exercise will enhance the client's gait, balance, and musculoskeletal strength. Limiting sun exposure will not impact the client's risk of experiencing a hip fracture. The nurse should not instruct the client to use throw rugs throughout the home because this could cause tripping, leading to a fall.

The nurse is caring for four clients. Which client should the nurse identify as having the highest risk for sustaining a hip fracutre if they sustain a fall? A) 60 y.o. man admitted for treatment of pneumonia B) 70 y.o. woman who consumes 800mg calcium/day C) 80 y.o. man admitted for BPH D) 50 y.o. woman with a history of osteoarthritis

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

A client with a BMI of 35 is recovering from total hip replacement surgery and experiencing pain that is exacerbated with movement. The client says to the nurse, "I live alone. How will I ever be able to return to my home?" Based on this information, which is the priority nursing diagnosis for this client? A) Overweight B) Acute Pain C) Impaired physical mobility D) Ineffective coping

B) Acute pain Rationale: The priority nursing diagnosis is Acute Pain. Unless this pain is controlled, the client will not be able to participate in interventions to address the nursing diagnosis of Impaired Physical Mobility. The diagnoses of Ineffective Coping and Overweight can be addressed after Acute Pain and Impaired Physical Mobility have been addressed.

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

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

A client is recovering from surgery to repair a fractured hip. Which actions by the nurse may reduce this client's risk for osteomyelitis in the post-op period? SATA A) Assess for pain every 1-2 hrs B) Use sterile techniques for dressing changes C) Assess wound for size, color, and drainage D) Administer antibiotics as prescribed E) Administer anticoagulants as prescribed

B, C, D Rationale: Interventions that can reduce the client's risk for infection include using sterile technique for dressing changes; assessing the wound for size, color, and drainage; and administering antibiotics as prescribed. Assessing for pain every 1-2 hours is appropriate for the nursing diagnosis of Acute Pain, but it does not help reduce the risk of osteomyelitis. Administering anticoagulants per order is appropriate for the client who is at risk for deep vein thrombosis (DVT), but again, it does not help reduce the risk of osteomyelitis.

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

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

A client is undergoing surgery for a fractured hip. The surgeon has stated that careful attention will be paid to preserving the epiphyseal plate. Which client will require this precaution? A) A postmenopausal woman with paraplegia B) A 32 year old man who is a competitive body builder C) A prepubescent girl who is vegetarian D) An 85 year old woman with osteoporosis

C) A prepubescent girl who is a vegetarian Rationale: Epiphyseal plates are unique joints that produce growth of bone length in children. There is an epiphyseal plate that lies between the head and neck of the femur that must be preserved during hip surgery in pediatric clients to prevent obstruction of bone growth. Of the clients listed here, only the prepubescent girl is young enough to have an epiphyseal plate. All of the other clients are older than 18-25 years of age, when the epiphyseal plate closes.

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

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

The first day after surgery to repair a fractured hip sustained from a fall, an older adult client refuses to ambulate but states, "I will consider it tomorrow." In this situation, which is the priority action by the nurse? A) Coordinate personnel to assist with ambulation B) Document the client's refusal C) Assess why the client is refusing to ambulate D) Notify the healthcare provider

C) Assess why the client is refusing to ambulate Rationale: The first thing the nurse should do is assess why the client is refusing to ambulate. The client might be fearful of falling, given that a prior fall resulted in a fractured hip. Following this assessment, the nurse could plan interventions that would facilitate ambulation, such as controlling pain and reducing the fear of falling. It is premature to notify the healthcare provider. The nurse should not force the client to get out of bed. Documenting the client's refusal is appropriate, but after determining the reason for the refusal.

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

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

A hip fracture that occurs in the trochanter region would be classified as a(n) A) Intracapsular fracture B) Intercapsular fracture C) Extracapsular fracture D) Subcapsular fracture

C) Extracapsular fracture Rationale: Hip fractures are broadly classified as either intracapsular or extracapsular. Intracapsular hip fractures occur at the head or neck of the femur within the capsule of the hip joint. Extracapsular hip fractures occur within the trochanter region, which is between the neck and diaphysis of the femur. Extracapsular fractures can be further divided into intertrochanteric or subtrochanteric. The terms intercapsular and subcapsular are not used to describe fractures of the hip.

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

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

The nurse is evaluating care provided to a client recovering from a hip replacement surgery. Which piece of documentation in the medical record indicates that the client has achieved the expected outcome for pain management? A) The client states pain is a 6/10 prior to evening care B) The client is crying and requesting pain medication prior to morning care C) The client is using a PCA pump around the clock and rates pain as a 2/10. D) The client refuses pain medication prior to physical therapy. Pain is rated at a 7/10

C) The client is using a PCA pump around the clock and rates pain as a 2/10 Rationale: Expected outcomes for pain management following hip replacement surgery are to minimize pain to a client rating of 3 or lower via medication administration, including use of patient-controlled analgesia (PCA) as appropriate. Completely eliminating pain is an unrealistic goal. Thus, only the client who is using the PCA pump and has a pain rating of 2 on a 0-to-10 scale has achieved an expected outcome for pain management.

For non-elderly adult clients who fracture a hip, why is internal fixation or casting of the fracture generally preferred over hip replacement? A) Internal fixation or casting is preferred because it does not disturb the client's epiphyseal plate B) Internal fixation or casting is preferred because of the lower risk of DVT C) Internal fixation or casting is preferred because of the shorter recovery time. D) Internal fixation or casting is preferred because of the limited longevity of hip prostheses.

D) Internal fixation or casting is preferred because of the limited longevity of hip prostheses. Rationale: Non-elderly adults are likely to live beyond the decade or so anticipated lifespan of a replacement hip. Internal fixation and casting are the preferred treatment methods for these clients because hip replacement may eventually necessitate revision surgery, which carries a greater level of risk than the initial hip replacement surgery. Protection of the epiphyseal plate is not a concern in adult clients, because they no longer have epiphyseal plates. Internal fixation, casting, and hip replacement all carry a similar risk of deep vein thrombosis, and none of these methods offers a definitive benefit in terms of recovery time.

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

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

An older adult client experiences a hip fracture. Prior to the injury, the client had an active lifestyle. Based on this information, which surgical procedure should the nurse anticipate? A) Total hip replacement B) Open reduction and external fixation C) Arthroplasty D) Open reduction and internal fixation

D) Open reduction and internal fixation Rationale: Open reduction and internal fixation is the preferred surgical procedure to repair a fractured hip for older adult clients who are active and will be able to use crutches with partial weight bearing following surgery. A total hip replacement, also called arthroplasty, is generally performed only when severe arthritis or an underlying bone condition is present, which does not appear to be the case given this client's activity level prior to the injury. Open reduction and external fixation is not a surgical option for a fractured hip.

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

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

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

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

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

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