LEWIS CH 63 Adaptive Quiz

A nurse evaluates a patient who reports twisting an ankle while walking down steps. Besides edema, which symptoms would most likely be observed if a nondisplaced simple fracture were present? 1 Numbness, coolness, and loss of pulse 2 Loss of sensation, redness, and warmth 3 Coolness, redness, and inability to bear weight Correct 4 Redness, warmth, and inability to use the affected part

Common signs of a fracture include edema, redness, warmth, inability to bear weight or use the affected joint, and pain at the site of injury. Coolness, tingling, numbness, and loss of pulses are signs of a vascular problem or may reflect a complication of a more complex fracture. Text Reference - p. 1512

A patient with a hip fracture has been treated with insertion of a prosthesis. What findings indicate dislocation of this prosthesis? Select all that apply. Correct 1 Limb shortening 2 Edema of the limb Correct 3 A lump in the buttock Correct 4 External rotation of the limb 5 Weak pulse in the limb

Symptoms such as sudden severe pain, a lump in the buttock, limb shortening, and external rotation indicate prosthesis dislocation. This requires a closed reduction with conscious sedation or open reduction to realign the femoral head in the acetabulum. Edema of the limb and a weak pulse can be due to other causes, such as compartment syndrome. Text Reference - p. 1526

A patient has presented with an unstable wrist fracture. What kind of cast is best for this patient? 1 Posterior splint 2 Short arm cast Correct 3 Long arm cast 4 Sugar-tong splint

The long arm cast is commonly used for stable forearm or elbow fractures and unstable wrist fractures. It is similar to the short arm cast but extends to the proximal humerus, restricting motion at the wrist and the elbow. The sugar-tong posterior splint accommodates post injury swelling in the fractured extremity. A short arm cast is used for stable wrist fractures. The sugar-tong splint is typically used for acute wrist injuries or injuries that may result in significant swelling. Text Reference - p. 1515

A nurse is caring for a patient with carpal tunnel syndrome who is advised to undergo surgical repair either by open release surgery or by endoscopic carpal tunnel release surgery. What possible advantages of an endoscopic approach over an open release approach should the nurse explain to the patient? Select all that apply. Correct 1 An endoscopic approach may allow faster recovery. 2 An endoscopic approach does not require rigorous wound care. Correct 3 An endoscopic approach may lead to less postoperative discomfort. 4 An endoscopic approach, unlike an open approach, requires only local anesthesia. Incorrect 5 An endoscopic approach, unlike an open approach, will shift the surgery to an outpatient setting.

1 An endoscopic approach may allow faster recovery. 3 An endoscopic approach may lead to less postoperative discomfort. Carpal tunnel release is recommended in patients whose symptoms last for more than 6 months. This may be done either by open release or by endoscopic release approaches. However, an endoscopic approach may have the advantages of faster recovery and less postoperative discomfort when compared with open release. The patient should be instructed about wound care and appropriate assessments to be performed at home for both approaches. Both of these techniques can be used in an outpatient setting and under local anesthesia. Text Reference - p. 1509

After a motor vehicle collision, a 30-year-old man has a dislocated right hip joint, and his right thigh bone is fractured into three pieces, with one piece of the bone exposed. What type of fracture should the nurse document? Select all that apply. 1 Open 2 Comminuted 3 Closed 4 Displaced 5 Greenstick

1 Open 2 Comminuted 4 Displaced In this case, the bone is exposed, and therefore it is an open fracture. Comminuted fractures have two or more fragments of bones. Fractures can be classified as displaced or nondisplaced. In a displaced fracture, the two ends of the broken bone are separated from one another and are out of their normal positions. This fracture is not a closed one, because the fractured bone is exposed through soft tissue injury. Greenstick fracture is a type of fracture in which the periosteum is intact across the fracture and the bone is still in alignment. TEST-TAKING TIP: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question. Text Reference - p. 1511

While completing an admission history for a 73-year-old man with osteoarthritis admitted for knee arthroplasty, the nurse asks him about his perception of the reason for admission. The nurse expects the patient to state: 1 Fractured patella 2 Chronic knee pain 3 Frequent and multiple falls 4 Total immobilization of his knee

2 Chronic knee pain The most common reason for knee arthroplasty is debilitating joint pain despite attempts to manage it with exercise and drug therapy. A fractured patella would be the result of a fall or trauma, not osteoarthritis. Frequent and multiple falls are not associated with osteoarthritis, and although pain is chronic, the knee will not be completely immobilized. Text Reference - p. 1535

A patient will undergo debridement of the shoulder joint. After the nurse explains the procedure, the patient asks the nurse what will be removed from the joint. How should the nurse answer? Select all that apply. 1 Synovial membrane 2 A wedge of bone 3 Joint debris 4 Degenerated menisci 5 Osteophytes

3 Joint debris 4 Degenerated menisci 5 Osteophytes The procedure of debridement involves removing from a joint any devitalized tissue, such as loose bodies, joint debris, degenerated menisci, and osteophytes. This procedure is usually performed on the knee or the shoulder using a fiber optic arthroscope. Removal of synovial membrane is called synovectomy. The removal of a wedge of bone is called osteotomy. Text Reference - p. 1534

The patient had a lumbar spine arthrodesis. What should the nurse include in discharge teaching? Select all that apply. Correct 1 Do not smoke cigarettes. Incorrect 2 You should not walk for three weeks. 3 You must wear your brace at all times. 4 You may drive as soon as you feel like it. Correct 5 Do not bend your spine until your follow-up appointment.

After a spinal fusion, the patient should not smoke cigarettes as nonunion tends to occur more often with smokers. Preventing pressure by not bending or twisting the spine or lifting more than 10 pounds will facilitate healing over time. The amount of time that is needed will be determined by the health care provider at follow-up appointments, but healing usually takes 6 to 9 months. An important aspect of healing is progressively increasing walking, which increases circulation of nutrients and oxygen for healing. If a brace is prescribed to protect the surgical area, the health care provider will prescribe how often the patient should wear it. Driving is not done until the health care provider allows it and the patient is no longer taking opioids for pain. TEST-TAKING TIP: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 1534

The nurse provides discharge instructions to a patient who has undergone total hip arthroplasty. Which statement by the patient indicates understanding of the instructions? 1 "I'll walk at least 2 miles a day after I get home." 2 "I may get back to work as soon as I feel that I'm able." Correct 3 "I have to do the physical therapy exercises several times a day." 4 "I should take frequent bike rides to increase my activity and joint flexibility."

After hip arthroplasty (replacement), the patient must perform specially designed exercises to help regain muscle strength. Care must be taken to prevent dislocation of the prosthesis and to prevent fatigue during the recovery period. Walking 2 miles per day and taking bike rides would put too much physical stress on the patient. Slow but steady progress will indicate when the patient's activity tolerance level is such that he or she may return to work. Text Reference - p. 1527

While examining a patient with an injury to the distal humerus, the nurse suspects that he has compartment syndrome. What findings in the patient could have raised this suspicion? Select all that apply. Incorrect 1 Pyrexia Correct 2 Paralysis of the arm Correct 3 Absence of the peripheral pulse Correct 4 Pain unrelieved by opioids 5 Redness and warmth

Compartment syndrome may occur initially from the body's physiologic response to the injury, or it may be delayed for several days after the injury. The usual signs include weakness and paralysis of the arm, absence of peripheral pulses, and pain that is not relieved by opioids. These signs are due to decreased compartment size resulting from an injury. The resultant pressure may compromise the function of blood vessels, nerves, or tendons that run through that compartment. Pyrexia indicates infection, but it is not a sign that suggests compartment syndrome. Redness and warmth may not be present; instead, the skin may be pale and cold to the touch. Text Reference - p. 1522

A 56-year-old patient is brought to the emergency department after an accident. A radiograph of the right femur shows a fracture. In this case, what should the attending nurse note during the peripheral vascular assessment? Select all that apply. 1 Pain Correct 2 Color Correct 3 Edema 4 Motor function Correct 5 Capillary refill

In cases related to fractures, peripheral vascular assessment should be done. This consists of assessment of color, temperature, capillary refill, peripheral pulses, and edema. Assessment of motor function and pain is included in the peripheral neurologic assessment. Text Reference - p. 1517

A 12-year-old boy fell on his right elbow and is complaining of severe pain. The nurse suspects fracture of the humerus. He has no complaints of problems with the lower limbs. During neurologic examination of the patient, which nerves should the nurse assess? Select all that apply. 1 Tibial nerve Correct 2 Ulnar nerve 3 Peroneal nerve Correct 4 Median nerve Correct 5 Radial nerves

It is important to evaluate sensory and motor functions of the ulnar, median, and radial nerves in cases of upper extremity injury. Assess neurovascular status by abduction and adduction of the fingers, opposition of the fingers, and supination and pronation of the hand. The tibial and peroneal nerves are assessed if there is any injury to the lower limbs. Text Reference - p. 1518

The nurse is caring for a patient with a fractured femur. Which nursing action(s) by the nurse is the priority? Select all that apply. Incorrect 1 Resting the extremity. Correct 2 Elevating the extremity. Correct 3 Providing analgesia as necessary. Correct 4 Compressing the involved extremity. Correct 5 Applying ice compresses to the injured area. Correct 6 Stopping the activity and limiting movement.

There are five interventions performed for an acute injury. Stopping the activity and limiting movement, applying ice compresses to the injured area, compressing the involved extremity, elevating the extremity, and providing analgesia as necessary. Resting the extremity is not included in the immediate care. Text Reference - p. 1585

When treating a patient with compartment syndrome, what measures should the nurse consider to be contraindicated? Select all that apply. 1 Elevation of the limb above heart level. 2 Bivalving of the bandage. 3 Application of cold compresses. 4 Reduction in traction weight. 5 Bandage removal.

1 Elevation of the limb above heart level. 3 Application of cold compresses. Elevation of the extremity may lower venous pressure and slow arterial perfusion. Therefore the extremity should not be elevated above heart level in case of compartment syndrome. Similarly, the application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome. It may also be necessary to remove or loosen the bandage and split the cast in half (bivalving). A reduction in traction weight may also decrease external circumferential pressures. Text Reference - p. 1522

A nurse is caring for a patient with a fractured femur. The health care provider finds that the patient has fat embolism syndrome. What treatment (or treatments) of fat embolism syndrome should the nurse anticipate for this patient? Select all that apply. 1 Fluid resuscitation 2 Avoidance of coughing 3 Correction of acidosis 4 Fracture immobilization 5 Frequent change in positions

1 Fluid resuscitation 3 Correction of acidosis 4 Fracture immobilization The treatment of fat embolism syndrome is directed toward the management of symptoms. This includes fluid resuscitation to prevent hypovolemic shock, correction of acidosis, and fracture immobilization. The patient should be encouraged to cough and perform deep breathing. The patient should be repositioned as little as possible to prevent dislodgment of fat droplets into the general circulation. Text Reference - p. 1523

A patient with a fracture of the femur is to be placed in Buck's traction. How should the nurse explain the functions of Buck's traction to the patient? Select all that apply. 1 It immobilizes the fracture. 2 It prevents hip flexion contractures. 3 It reduces muscle spasms. 4 It reduces injury-related edema. 5 It helps in union of the fractured bone.

1 It immobilizes the fracture. 2 It prevents hip flexion contractures. 3 It reduces muscle spasms. Traction is the application of a pulling force to an injured or diseased part of the body, often an extremity. A Buck's traction boot is a type of skin traction used to immobilize the fracture, prevent hip flexion contractures, and reduce muscle spasms. The traction does not reduce edema or directly help in union of the fractured bone. However, it indirectly helps the process of union of the fractured bone by keeping the limb aligned and reducing spasms and contractures. Text Reference - p. 1514

What measures should a nurse take to prevent muscle spasms in cases of musculoskeletal injuries? Select all that apply. 1 Massage the muscle spasms. 2 Align the affected extremity appropriately. 3 Use thermotherapy on the affected extremity. 4 Place the affected extremity in a comfortable position. 5 Provide isometric muscle strengthening exercises.

2 Align the affected extremity appropriately. 3 Use thermotherapy on the affected extremity. 4 Place the affected extremity in a comfortable position. Muscle spasms are caused by involuntary muscle contraction after fracture, strain, or nerve injury. These may displace a nondisplaced fracture or prevent it from healing spontaneously. Therefore it is important to take measures to prevent muscles spasms. The affected extremity should be aligned appropriately. Thermotherapy may reduce muscle spasm. The extremity should be placed in a comfortable position. Massaging a muscle spasm may stimulate muscle tissue contraction, further increasing pain and spasm. Therefore it is not advisable to massage spasms. An isometric muscle strengthening exercise regimen will not prevent muscle spasms in this injured patient. Text Reference - p. 1521

A 65-year-old patient who was admitted with Parkinson's disease fell down some stairs in the hospital. The nurse who was caring for him finds that he is conscious and is complaining of severe pain in the calf muscles. There are no apparent bone fractures. What should be the immediate course of action for the nurse? Select all that apply. 1 Apply hot compresses. 2 Apply ice to the painful area. 3 Encourage the patient to mobilize the limb. 4 Elevate the affected limb. 5 Restrain the patient to the bed.

2 Apply ice to the painful area. 4 Elevate the affected limb. If an injury occurs, the immediate care focuses on applying ice compresses to the injured area to reduce pain, muscle spasms, inflammation, and edema. The affected limb should be elevated to mobilize excess fluid from the area and prevent further edema. The nurse should instruct the patient to limit movements of the affected limb. After the acute phase (usually 24 to 48 hours) moist heat may be applied to the affected area to reduce swelling and provide comfort. Restraining the patient to the bed is not related to the management of this injury. Text Reference - p. 1507

A 56-year-old patient is brought to the emergency department after an accident. A radiograph of the right femur shows a fracture. In this case, what should the attending nurse note during the peripheral vascular assessment? Select all that apply. 1 Pain 2 Color 3 Edema 4 Motor function 5 Capillary refill

2 Color 3 Edema 5 Capillary refill In cases related to fractures, peripheral vascular assessment should be done. This consists of assessment of color, temperature, capillary refill, peripheral pulses, and edema. Assessment of motor function and pain is included in the peripheral neurologic assessment. Text Reference - p. 1517

While providing discharge teaching to a patient with a fiberglass cast, the nurse explains that the major disadvantage of this type of cast is that: 1 It must not get wet 2 It has to be replaced every 1 to 2 weeks 3 The fiberglass is heavier than a plaster cast 4 Skin irritation is more common than with a plaster cast

4 Skin irritation is more common than with a plaster cast Although there are many advantages of fiberglass casts, such as its capacity to withstand wetness and its lightness compared to plaster, the one major disadvantage is that the particles of fiberglass may be irritating to the skin. A fiberglass cast is water-repellent and does not require replacement if it becomes wet. A fiberglass cast may remain on the patient for the duration of the treatment and does not require replacement every 1 to 2 weeks. A fiberglass cast is lighter than plaster. Text Reference - p. 1515

What action should a nurse should implement to prevent foot drop in a patient who has a full-leg cast? 1 Encourage bed rest 2 Maintain the foot in a boot with 45 degrees of flexion Correct 3 Support the foot with 90 degrees of flexion 4 Place an antiembolic garment on the affected leg and foot.

As a means of preventing foot drop in a leg with a cast, the foot should be supported with 90 degrees of flexion. Encouraging bed rest for his patient is not required. Supporting the foot with 45 degrees of flexion will not prevent foot drop. Antiembolic garments will protect against thromboembolic events but not foot drop. Text Reference - p. 1521

When attending a patient who has undergone hip replacement surgery, what interventions should a nurse perform to prevent thromboembolism? Select all that apply. Correct 1 Administer a prophylactic anticoagulant drug, such as warfarin (Coumadin). Correct 2 Administer low-molecular-weight heparin, such as enoxaparin (Lovenox). Correct 3 Apply compression gradient stockings. 4 Avoid moving toes of the affected extremities. 5 Perform range-of-motion exercises on the affected extremity.

Because of the high risk of venous thromboembolismin the orthopedic surgical patient, prophylactic anticoagulant drugs, such as warfarin (Coumadin), or low-molecular-weight heparin, such as enoxaparin (Lovenox), may be prescribed. In addition to wearing compression gradient stockings, the patient should move (dorsiflex and plantar flex) the toes of the affected extremity against resistance and perform range-of-motion exercises on the unaffected lower extremities. Text Reference - p. 1527

What instructions should be given to a patient with a cast to prevent edema and skin breakdown? Select all that apply. 1 Elevate the affected limb above heart level during the first 48 hours. 2 Apply ice on the fracture site during the first 24 hours. 3 Cover the cast with plastic for prolonged periods. 4 Remove the padding of the cast after going home.

1 Elevate the affected limb above heart level during the first 48 hours. 2 Apply ice on the fracture site during the first 24 hours. 5 Exercise joints above and below the cast. Regardless of the type of cast material, a cast can interfere with circulation and nerve function if edema occurs after the application of the cast. Therefore, it is important to teach the patient and caregivers about measures to prevent edema. Elevating the limb above heart level and applying ice in the initial phase (24 to 48 hours) help in preventing edema. The patient should also be encouraged to exercise the joints above and below the cast. Pulling out the cast padding, inserting foreign objects into the cast to scratch an itch, and covering the cast with plastic may predispose patients to skin breakdown and infections. Therefore they should be advised to abstain from doing such things. Text Reference - p. 1520

A nurse is caring for a patient with reported fracture of the tibia. A plaster cast has been applied to the patient. What interventions are important for the care of the cast during the drying period and immediately thereafter? Select all that apply. 1 Cover the cast with a cloth. 2 Avoid direct pressure on the cast. 3 Handle the cast gently with an open palm. 4 Avoid petaling the cast. 5 Place several strips of tape over the rough edges.

2 Avoid direct pressure on the cast. 3 Handle the cast gently with an open palm. 5 Place several strips of tape over the rough edges. Avoid direct pressure on the cast during the drying period. Handle the cast gently with an open palm to avoid denting the cast. The health care provider should place several strips (petals) of tape over the rough areas to ensure a smooth cast edge. A fresh plaster cast should never be covered, because covering it prevents air from circulating; this lack of air circulation allows heat to build up in the cast (which may cause a burn) and may also result in a delay in drying. After drying, the edges may need to be petaled to avoid skin irritation from rough edges and to prevent plaster of Paris debris from falling into the cast and causing irritation or pressure necrosis. Text Reference - p. 1520

A patient with a fracture of the right tibia has been advised to use a cane. What instructions should the nurse give to this patient? Select all that apply. 1 Hold the cane in the right hand. 2 Hold the cane in the left hand. 3 Advance the right leg first. 4 Advance the left leg first. 5 Advance the right leg last. 6 Advance the left leg last.

2 Hold the cane in the left hand. 3 Advance the right leg first. 6 Advance the left leg last. The decision to use assistive devices is made by the health care provider depending on the needs and lifestyle of patient. Use of these devices varies. When a cane is used, the affected limb is advanced along with or after the cane, and the unaffected limb is advanced last. The cane is held in the hand opposite the affected limb. In this case, the right leg is affected, and therefore the cane should be held in the left hand, the right leg should be advanced first, and the left leg should be advanced last. Text Reference - p. 1521

A patient with a fracture of the humerus is advised to have a cast made of synthetic material. How should the nurse explain the benefits of casts made of synthetic materials, compared with plaster casts? Select all that apply. 1 Synthetic casts are of a heavier weight. 2 Synthetic casts are stronger. 3 Synthetic casts are permeable to water. 4 Synthetic casts provide for early weight bearing. Correct 5 Synthetic casts can be easily molded to fit the torso or extremity.

2 Synthetic casts are stronger. 4 Synthetic casts provide for early weight bearing. Casts made of synthetic materials are being used more than plaster casts because they are stronger and provide for early weight bearing. The synthetic casting materials (thermolabile plastic, thermoplastic resins, polyurethane, and fiberglass) are activated by submersion in cool or tepid water. Then they are molded to fit the torso or extremity. Synthetic casts are not heavy—in fact, they are lightweight; and they are water-resistant. Text Reference - p. 1515

A nurse is caring for a patient who has just sustained a hip fracture. Which nursing action should be performed first? 1 Administering pain medication 2 Preparing for immediate surgery 3 Immobilizing the affected extremity 4 Placing the injured extremity in traction

3 Immobilizing the affected extremity The priority of emergency management for a fractured hip is immobilizing the affected extremity, because movement could cause further damage and more extensive internal bleeding and worsen the patient's pain. Administering pain medication, preparing the patient for immediate surgery, and placing the injured extremity in traction are secondary nursing interventions that require further direction from the primary health care provider. Text Reference - p. 1525

A patient has an injury to the eye. On examination, the nurse finds a brown tissue on the surface of the ocular globe and a teardrop-shaped pupil. What should the nurse do next? Select all that apply. 1 Assess for the function of cranial nerves. 2 Send the patient for a computed tomography (CT) scan. 3 Stop further examination of the eye. 4 Place a protective shield over the eye. 5 Put antibiotic eyedrops in the eye.

3 Stop further examination of the eye. 4 Place a protective shield over the eye. The presence of brown tissue (iris or ciliary body) on the surface of the globe, extrusion of vitreous humor, and an eccentric or teardrop-shaped pupil indicate rupture of the globe. When such an injury is suspected, it is important to stop the examination and place a protective shield over the involved eye. Assessment of the function of the cranial nerves and sending the patient for a CT scan are done in the case of any facial fractures, but they aren't directly related to the eye assessment. Because this is a case of globe rupture, antibiotic eyedrops should be given only per the prescription of an ophthalmologist. TEST-TAKING TIP: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax. Text Reference - p. 1529

A patient experiences a fat embolism. What clinical manifestations does the nurse expect? 1 Tachypnea, tachycardia, shortness of breath, and paresthesia 2 Paresthesia, bradycardia, bradypnea, petechial rash on the chest and neck Correct 3 Tachypnea, tachycardia, shortness of breath, petechial rash on the chest and neck Incorrect 4 Bradypnea, bradycardia, shortness of breath, petechial rash on the chest and neck

A fat embolism may occur in a patient who has had a fracture of a large bone such as a femur or hip. The classic symptoms of a fat embolism include tachypnea, tachycardia, shortness of breath, and petechial rash on the chest and neck. Tachypnea, tachycardia, shortness of breath, and paresthesias; paresthesias, bradycardia, bradypnea, and petechial rash; and bradypnea, bradycardia, shortness of breath, and petechial rash are not directly characteristic of a pulmonary embolism. Text Reference - p. 1523

Which discharge instructions would a nurse give to a patient with a cast? Select all that apply. 1 Use talcum powder under the cast as needed. Correct 2 Keep the extremity elevated as much as possible. 3 Take pain medications only when the pain is unbearable. Correct 4 Report a fever or a foul odor coming from beneath the cast. 5 Report itching under the cast that could indicate an infection. 6 Keep the extremity in a dependent position as much as possible.

A fever or a foul odor coming from beneath the cast may indicate an infection and requires immediate attention. No product such as talcum powder, cornstarch, or lotion should be put down a cast to relieve itching, because this may increase the risk of infection. If pain is present, the patient should take pain medication before reaching an unbearable level. Itching under the cast is normal and does not need to be reported to the primary healthcare provider, but the patient must be advised to avoid scratching, because breaks in the skin under the cast can easily become infected. The extremity should be elevated as much as possible to prevent edema. Keeping the extremity elevated, not dependent, decreases edema. Text Reference - p. 1520

The patient had tibia and fibula fractures and an open reduction, and now has a cast. The patient wants to know when he or she will be able to resume jazzercise classes. To answer this question, the nurse must first understand that the following stages of union occur in what order? Correct 1. Fracture hematoma Correct 2. Granulation Correct 3. Callus formation Correct 4. Ossification Correct 5. Consolidation Correct 6. Remodeling

A fracture hematoma occurs in the first 72 hours after the fracture injury. Granulation produces the basis for new bone substance 3 to 14 days after injury. Callus formation, composed of cartilage, osteoblasts, calcium, and phosphorus, appears by the end of the second week after injury. Ossification of the callus will prevent movement at the fracture when the bones are gently stressed, occurs from three weeks to six months after the fracture, and continues until the fracture is healed. Consolidation is when the distance between bone fragments diminishes and there is radiologic union. Remodeling is the reabsorption of excess bone tissue in the final stage of bone healing and occurs in response to gradually increased stress on the bone or weight bearing. Text Reference - p. 1512

The nurse is instructed to apply a swathe to a patient. What is true about a swathe? Select all that apply. Correct 1 It is used for shoulder dislocations. 2 It is used for hip dislocations. Correct 3 It encircles the trunk and humerus. 4 It encircles the trunk and femur. Correct 5 It may be used after surgical repairs.

A swathe is a type of immobilizer used to prevent glenohumeral movement. It encircles the trunk and humerus as an additional binder and is often used after surgical repairs or shoulder dislocations. It is not used for hip dislocations and is not used to encircle the trunk and femur. Text Reference - p. 1524

A nurse is examining a patient who is in a body jacket brace. The patient complains that the brace is applied too tightly. What findings in the patient may indicate that the brace is too tightly applied? Select all that apply. Incorrect 1 Burning sensation Correct 2 Abdominal pain Incorrect 3 Guarding and rigidity Correct 4 Increased abdominal pressure Correct 5 Nausea and vomiting

After application of the body jacket brace, it is important to assess the patient for the development of superior mesenteric artery syndrome (cast syndrome). This condition occurs if the brace is applied too tightly, compressing the superior mesenteric artery against the duodenum. The patient generally complains of abdominal pain, abdominal pressure, nausea, and vomiting. Burning sensations, guarding, and rigidity may not be found in cast syndrome; these symptoms are more prominent if an intraabdominal disorder is present. Text Reference - p. 1516

A patient with a fracture of the femur has the extremity in skeletal traction and is encouraged to use an overhead trapeze apparatus. The nurse explains that the primary purpose of the overhead trapeze is: 1 To assist with leg exercises 2 To enhance breathing and lung expansion 3 To promote circulation throughout the body Correct 4 To facilitate independent movement while the patient is in bed

An overhead trapeze will facilitate independent movement in bed. It also maintains range of motion of the upper extremities and strengthens the biceps. Assisting with stump exercises, enhancing breathing and lung expansion, and promoting circulation throughout the body are secondary benefits to using an overhead trapeze but are not the primary purpose. Text Reference - p. 1526

A nurse has applied Buck's traction to a patient who has sustained a fractured femur. What are the main purposes of this type of traction? Select all that apply. Correct 1 Reduce muscle spasms 2 Reduce the risk of a fat embolism Incorrect 3 Repair the fracture without surgery Correct 4 Immobilize and stabilize the fracture 5 Reduce the amount of analgesics required 6 Allow the nursing staff to care for the patient more easily

Buck's traction, a type of skin traction, is used to stabilize and immobilize a fractured femur. This type of traction decreases the risk for further injury until surgery can be performed and can also ease painful muscle spasms. Buck's traction may reduce the risk of a fat embolism. Secondarily Buck's traction may be used long-term until the patient is able to undergo surgery, but this is not the preferred treatment. Once muscle spasms have been relieved after the application of Buck's traction, the patient may require less pain medication. Buck's traction does not necessarily allow the nursing staff to care for the patient more easily. Text Reference - p. 1514

A 25-year-old man is brought to the hospital with blood stains on his clothes and active bleeding from the nose. His right arm is deformed. The people who brought him in informed the nurse that he was found in this condition on the road. Prioritize the initial interventions to be done in this case. Correct 1. Check if there is blood in the mouth. Correct 2. Check for respiratory rate. Correct 3. Check for pulse rate. Correct 4. Assess the neurovascular status of the right arm.

Emergency management of any injury involves assessment of A (air way), B (breathing), and C (circulation), in that order. Therefore in this patient the attending nurse should first check for any blood in the mouth blocking the airway, then check for respiratory effort to see if the patient is breathing, then check for a pulse to see if circulation of blood is normal, and then assess the neurovascular status of the affected limb (in this case, the right arm). TEST-TAKING TIP: What happens if you find yourself in a slump over the examination? Take a time-out to refocus and reenergize! Talk to friends and family who support your efforts in achieving one of your major accomplishments in life. This effort will help you regain confidence in yourself and get you back on track toward the realization of your long-anticipated goal. Text Reference - p. 1529

A nurse is planning discharge teaching for home care for a patient after hip replacement surgery. What exercises should be taught to the patient to restore strength and muscle tone in the quadriceps and muscles related to the hip? Select all that apply. Correct 1 Tightening of the kneecap Correct 2 Tightening of the buttocks Correct 3 Leg raises in a supine position 4 Sitting while crossing the legs 5 Swinging the leg when standing, with the swing crossing the midline

Exercises designed to restore strength and muscle tone in the quadriceps and muscles about the hip are essential to improve function and range of motion. These include quadriceps setting (tightening the kneecap), gluteal muscle setting (tightening the buttocks), and leg rises in supine and prone positions. The abduction exercises from the supine and standing positions can be done, but the legs should not cross the midline. The patient should be instructed not to use a sitting position with crossed legs, because it can dislocate the hip. Text Reference - p. 1527

A nurse is completing the discharge sheet for a patient with hip fracture, who has been treated by insertion of a prosthesis using a posterior approach. What instructions should be given to this patient before discharge? Select all that apply. 1 An adaptive device is not necessary for putting on shoes. 2 Use low toilet seats and chairs without arms. Correct 3 Place a chair inside the tub and remain seated while washing. Correct 4 Keep the hip in a neutral, straight position when sitting or lying. Correct 5 Inform the dentist about the prosthesis before any dental work.

For a patient who had a hip fracture and has been treated by insertion of a prosthesis using a posterior approach, it is important to teach him and his caregiver about the measures to prevent dislocation. Certain measures, such as placing a chair in the tub and remaining seated while washing and keeping the hip in a neutral and straight position when sitting, lying, or walking prevents dislocation. The patient should be advised to inform his dentist about the prosthesis before any dental work so that prophylactic antibiotics can be given if indicated. Many positions and daily activities predispose the patient to the dislocation of the prosthesis. Some of these activities include putting on one's own shoes and socks without using adaptive devices; crossing the legs or feet while seated; assuming the side-lying position incorrectly; standing up or sitting down while the body is flexed more than 90 degrees relative to the chair; and sitting on low seats, especially low toilet seats. It is also important to sit in chairs with arms, because these help the patient to rise to a standing position. Text Reference - p. 1527

A patient has been admitted to the hospital for a scheduled knee arthroplasty. What should a nurse do in the preoperative management of this patient? Select all that apply. Incorrect 1 Assess muscle strength in the lower limbs. Correct 2 Assess muscle strength in the upper limbs. Incorrect 3 Assess joint function of the lower limbs. Correct 4 Assess joint function of the upper limbs. Incorrect 5 Assess pain sensation in the lower limbs. 6 Assess pain sensation in the upper limbs.

If lower extremity surgery is planned, the nurse should assess upper extremity muscle strength and joint function to determine the type of assistive devices needed postoperatively for ambulation and activities of daily living. Therefore, in this case, the assessment of muscle strength and joint function of the upper limbs is required. Assessment of pain sensation is not important. Text Reference - p. 1535

A nurse is taking care of a patient with a cast on the right leg maintained in external traction. However, during the routine examination, the nurse finds that the patient has compartment syndrome. What measures should a nurse take in the management of this patient? Select all that apply. Correct 1 Cut the cast in half. Correct 2 Remove or loosen any bandage. 3 Elevate the affected limb above heart level. 4 Apply cold compresses to the leg. Correct 5 Reduce external traction weight.

If the patient has compartment syndrome, the cast should be split in half. If there are any bandages, they should be removed or loosened to remove the pressure. A reduction in traction weight may also decrease external circumferential pressures. Elevation of the extremity may lower venous pressure and slow arterial perfusion. Therefore the extremity should not be elevated above heart level. The application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome. Text Reference - p. 1522

A 40-year-old man has a mandibular fracture from an accident, and there is prominent swelling around it. What are the important nutritional measures that need to be followed in the postoperative stages? Select all that apply. Correct 1 Include liquid protein supplements. Correct 2 Give prune juice to drink. Correct 3 Administer bulk-forming laxatives. 4 Give a low-carbohydrate, high-bulk diet. 5 Instruct the patient to chew food properly.

Ingestion of sufficient nutrients poses a challenge because the diet must be liquid. The patient easily tires of sucking through a straw or laboriously using a spoon. Liquid protein supplements may be helpful for improving the nutritional status. The low-bulk, high-carbohydrate diet and the intake of air through the straw can create problems related to constipation and flatus. Prune juice and bulk-forming laxatives may help to ward off these problems. The constraint of the diet to only liquids usually results in a low-bulk, high-carbohydrate diet. Chewing is not applicable here, because the diet must be liquid with any form of mandibular immobilization. Text Reference - p. 1530

On return from surgery, the patient is wearing intermittent sequential compression stockings that the patient does not want to keep on. How should the nurse explain their necessity to the patient while on bed rest? 1 The stockings keep the legs warm while the patient is not moving much. 2 The stockings maintain the blood flow to the legs while the patient is on bed rest. 3 The stockings keep the blood pressure down while the patient is stressed after surgery. Correct 4 The stockings provide compression of the veins to keep the blood moving back to the heart.

Intermittent sequential compression stockings provide compression of the veins while the patient is not using skeletal muscles to compress the veins, which keeps the blood moving back to the heart and prevents blood pooling in the legs that could cause deep vein thrombosis. The warmth is not important. Blood flow to the legs is not maintained. Blood pressure is not decreased with the use of intermittent sequential compression stockings. Text Reference - p. 1523

A patient with osteoarthritis is about to undergo total left-knee arthroplasty. The nurse assesses the patient carefully to be sure that there is no evidence of which sign in the preoperative period? 1 Immobility 2 Pain 3 Inflammation Correct 4 Infection

It is critical that the patient be free of infection before a total knee arthroplasty. An infection in the joint could lead to even greater pain and joint instability, requiring extensive surgery. For this reason, the nurse monitors the patient for signs of infection, such as redness, swelling, fever, and increased white blood cell count. Pain, immobility, and inflammation are common findings in the patient with osteoarthritis and would not be contraindications to surgery. Text Reference - p. 1535

A patient is admitted to the hospital with an open fracture. What should the nurse do to prevent infection of the fracture wound in this patient? Select all that apply. Correct 1 Administer prophylactic antibiotics. 2 Assess the neurovascular status of the limb. 3 Ensure airway, breathing, and circulation. Correct 4 Administer tetanus and diphtheria prophylaxis. 5 Immobilize the affected extremity in the position found.

It is very important to administer tetanus prophylaxis, diphtheria prophylaxis, and prophylactic antibiotics to a patient with open fractures to prevent any infections. Open fractures are predisposed to be contaminated, and therefore patients are exposed to higher risk of infections. Other measures, including assessing the neurovascular status of the limb; ensuring airway, breathing, and circulation; and immobilizing the affected limb in the position found, are also important, but these activities do not help in preventing infection of the open fracture wound. Text Reference - p. 1522

During the discharge of an older patient who has had a history of repeated falls at home, what instructions should a nurse give to the patient to prevent falls? Select all that apply. 1 Avoid weight-bearing exercises. Correct 2 Use a walker or cane. Correct 3 Exercise fingers and toes. 4 Never use ramps in buildings. Correct 5 Avoid walking on uneven surfaces.

It is very important to teach older patients about the correct measures to prevent falls. Some of these include using a walker or cane while walking and avoiding walking on uneven surfaces. It is also important to develop hobbies, such as needlework or jigsaw puzzles that help to exercise the fingers, and to exercise the toes, thus preventing stiffness. Using ramps in buildings and on street corners, instead of steps, can decrease the risk of falling. Weight-bearing exercises should be performed, because they are important to maintain the strength of the bones and joints. Text Reference - p. 1506

An 80-year-old woman arrives in the emergency department after sustaining a fall. The initial assessment reveals that the left leg is shorter than the right and externally rotated. The nurse should suspect: Correct 1 Fractured hip 2 Fractured pelvis 3 Nondisplaced fractured femur 4 Fractured tibia/fibula

Older adults, especially women, are at high risk for fracture. One classic sign of a fractured hip is a leg that is shorter than the opposite one and abnormally rotated (internally or externally). A fractured hip is accompanied by pain and possibly neurovascular changes. A leg that is shorter than the other one and externally rotated is not a sign of a fractured pelvic, femur, or tibia/fibula. Text Reference - p. 1525

A nurse is caring for a patient who has undergone a knee joint replacement. What measures should a nurse take to prevent constipation of the patient in the postoperative period? Select all that apply. Correct 1 Advise the patient to drink more than 2500mL/day of fluids. 2 Instruct the patient to drink cold fluids. Correct 3 Advise the patient to eat more fruits and vegetables. 4 Advise the patient to maintain complete bed rest until recovery. Correct 5 Use stool softeners and laxatives as advised.

Patients often have reduced mobility after a fracture, which may result in constipation. The nurse should implement appropriate measures, such as high fluid intake (more than 2500mL/day unless contraindicated) and a diet high in bulk and roughage (fruits and vegetables) to prevent constipation. If these measures fail to maintain normal bowel pattern, then laxatives and stool softeners can be used. Constipation can be relieved by drinking warm fluids, not cold ones. Physical activity also helps in bowel activity, so the patient should ambulate as early as the indications and provider prescriptions allow. Text Reference - p. 1519

A nurse explains the process of fracture healing to a patient who has a tibial fracture. Arrange the stages of fracture healing in their correct order. Correct 1. Fracture hematoma Incorrect 2. Callus formation Incorrect 3. Remodeling Incorrect 4. Consolidation Incorrect 5. Granulation tissue Incorrect 6. Ossification

The multistage healing process of bone is called union. Stages include fracture hematoma formation and conversion of this hematoma into granulation tissue. Granulation tissue forms the basis for new bone matrix, called osteoid, and as the minerals and new bone matrix get deposited in osteoid, a callus is formed. This callus undergoes ossification from 3 weeks to 6 months after fracture. As the callus continues to grow, the distance between bone fragments is diminished; this process is called consolidation. In the final stage, called remodeling, excess bone tissue is reabsorbed, and union is complete. Text Reference - p. 1512

A patient status post right total knee arthroplasty has a prescription to get out of bed to the chair. Which action would the nurse take to protect the knee joint while carrying out the prescription? 1 Use a walker and two-person transfer technique. 2 Transfer the patient to the chair using a mechanical lift. 3 Ask the physical therapist to assist to limit weight bearing while the patient gets out of bed. Correct 4 Ensure a knee immobilizer is in place and elevate the leg while sitting.

The nurse should apply a knee immobilizer for stability before helping the patient out of bed. This is a standard measure to protect the knee during movement after surgery. A mechanical lift would not be necessary as the patient can fully weight bear on the unaffected leg. A walker and assistance from the physical therapist may be considered, but the priority action would be to stabilize the knee and elevate it while sitting. TEST-TAKING TIP: Have confidence in your initial response to an item because it more than likely is the correct answer. Text Reference - p. 1535

A patient with severe osteoarthritis of the left knee has undergone left-knee arthroplasty with prosthetic replacement of the knee joint. After surgery, the nurse expects to include which intervention? 1 Active range of motion every hour 2 Strict bedrest for 24 hours 3 Total knee immobilization for 72 hours Correct 4 Physical therapy to achieve full knee flexion

The patient is encouraged to engage in progressive leg exercises until 90-degree flexion is possible. Because this is painful after surgery, the patient requires good pain management and, often, the use of a continuous passive motion (CPM) machine. Hourly range of motion is not necessary as the patient will already have CPM. Bed rest is not indicated because of the risk of clot formation postoperatively. Knee immobilization should be used when transferring out of bed, but should not be left on. Text Reference - p. 1535

The nurse is completing discharge teaching with an 80-year-old male patient who underwent right total hip arthroplasty. The nurse identifies a need for further instruction if the patient states the need to: 1 Avoid crossing his legs 2 Use a toilet elevator on toilet seat 3 Notify future caregivers about the prosthesis Correct 4 Maintain hip in adduction and internal rotation

The patient should not force hip into adduction, or force hip into internal rotation, as these movements could displace the hip replacement. Avoiding crossing the legs, using a toilet elevator on a toilet seat, and notifying future caregivers about the prosthesis indicate understanding of discharge teaching. Text Reference - p. 1536

When performing the physical examination of a patient, how should the nurse assess the function of the peroneal nerve? Select all that apply. Correct 1 Assess dorsiflexion of the foot. 2 Assess plantar flexion of the foot. Correct 3 Assess sensation in the sole of the foot between the first and second toes. 4 Assess sensation in the sole of the foot between the third and fourth toes. 5 Assess sensation in the dorsal part of the foot between the first and second toes.

The peroneal nerve has motor and sensory functions. The motor function is assessed by looking for dorsiflexion of the foot, whereas the sensory function is assessed by looking for sensation on the dorsal aspect of the foot between the first and second toes. Plantar flexion of the foot and sensory supplies to the sole of the foot are the functions of the tibial nerve. The function of the peroneal nerve is not assessed by sensation in the sole of the foot between the third and fourth toes or by sensation in the dorsal part of the foot between the first and second toes, because the peroneal nerve does not supply these areas. Text Reference - p. 1518

A 35-year-old man fell from a 20-foot height onto his right elbow. The radiograph revealed a fracture in the middle third of the right humerus, with sharp edges. What are the structures that may be at risk of damage due to the sharp edges of broken bone in this patient? Select all that apply. 1 Axillary nerve Correct 2 Radial nerve Incorrect 3 Brachial plexus Correct 4 Brachial artery Incorrect 5 Ulnar nerve

The radial nerve is present in the axillary groove of the humerus, and the brachial artery is located on the anterior aspect of the humerus. Therefore the radial nerve and brachial artery are likely to be damaged by the sharp edges of fractured bone margins of the humerus. The axillary nerve and brachial plexus are present in the axilla. Therefore they are unlikely to be damaged. The ulnar nerve is usually unaffected by bone fractures, owing to the presence of muscles and soft tissues. Text Reference - p. 1524

A patient is admitted to the orthopedic surgical unit for a fracture of the left tibia. What instructions should a nurse give concerning the prevention of venous thromboembolism? Select all that apply. Correct 1 Wear compression gradient stockings. 2 Perform range-of-motion exercises on the left lower limb. Correct 3 Perform range-of-motion exercises on the right lower limb. Correct 4 Exercise toes of the left lower limb against resistance. 5 Exercise toes of the right lower limb against resistance.

There is a high risk of venous thromboembolism in the orthopedic surgical patient. Therefore measures should be taken by the attending nurse to prevent it. These measures include instructing the patient to wear compression gradient stockings (antiembolism hose) and to use sequential compression devices. The patient should also be encouraged to move (dorsiflex and plantar flex) the fingers or toes of the affected extremity against resistance and perform range-of-motion exercises on the unaffected lower extremities. Text Reference - p. 1523

An acutely injured elderly man complains of chest pain. The nurse examining him found petechiae located around the neck, the anterior chest wall, the axillae, the buccal membrane, and the conjunctivae of the eyes. Also, the radiograph revealed a fracture of the hip bone. After a chest radiograph is taken, blood tests are sent for investigation. What might be found if the patient has fat embolism syndrome? Select all that apply. Correct 1 Decreased platelet count 2 Increased hematocrit Correct 3 Prolonged prothrombin time Correct 4 Pulmonary infiltration on chest radiograph Incorrect 5 Increased partial pressure of arterial oxygen Topics

This patient's signs and symptoms indicate that he has a condition called acute respiratory distress syndrome, caused by fat emboli. Petechiae located around the neck, the anterior chest wall, the axillae, the buccal membrane, and the conjunctivae of the eyes helps distinguish fat emboli from other problems. Results of blood tests show decreased platelet count and prolonged prothrombin time. A chest radiograph may reveal areas of pulmonary infiltrate or multiple areas of consolidation. The partial pressure of arterial oxygen (PaO2) and hematocrit are decreased. Text Reference - p. 1523

A patient with a fracture of the right tibia is scheduled for application of a cast. What is the correct order of applying the materials, from inside to outside? Correct 1. Cover the affected part with a stockinette. Correct 2. Place padding over the stockinette. Correct 3. Immerse plaster of Paris in warm water. Correct 4. Wrap plaster of Paris around the affected part.

To apply a cast on an extremity, first cover the affected part with a stockinette that is cut longer than the extremity. Then place padding over the stockinette, with the bony prominences given extra padding. If the casting material used is plaster of Paris, it is usually immersed in warm water before being wrapped and molded around the affected part. The number of layers of plaster bandage and the technique of application determine the strength of the cast. The plaster sets within 15 minutes. Text Reference - p. 1520

A patient with a fracture of the right tibia is scheduled for application of a cast. What is the correct order of applying the materials, from inside to outside? Incorrect 1. Immerse plaster of Paris in warm water. Incorrect 2. Cover the affected part with a stockinette. Incorrect 3. Place padding over the stockinette. Correct 4. Wrap plaster of Paris around the affected part.

To apply a cast on an extremity, first cover the affected part with a stockinette that is cut longer than the extremity. Then place padding over the stockinette, with the bony prominences given extra padding. If the casting material used is plaster of Paris, it is usually immersed in warm water before being wrapped and molded around the affected part. The number of layers of plaster bandage and the technique of application determine the strength of the cast. The plaster sets within 15 minutes. Text Reference - p. 1520