ms prep u

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures?

Hemorrhage and shock Bleeding occurs because of blood vessel damage from fracture fragments due to laceration of veins and arteries and possibly a torn iliac artery.

A fracture is considered pathologic when it

occurs through an area of diseased bone. Pathologic fractures can occur without the trauma of a fall. An avulsion fracture results in a fragment of bone being pulled away by a ligament or tendon and its attachment. A greenstick fracture presents as one side of the bone being broken and the other side being bent. A compound fracture involves damage to the skin or mucous membranes.

A client had an above-the-knee amputation of the left leg related to complications from peripheral vascular disease. The nurse enters the client's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse?

Apply a tourniquet. Following an amputation, immediate postoperative bleeding may develop slowly or may take the form of massive hemorrhage resulting from a loosened suture. A large tourniquet should be in plain sight at the client's bedside so that if severe bleeding occurs, it can be applied to the residual limb to control the hemorrhage. The nurse immediately notifies the surgeon in the event of excessive bleeding.

An older adult client has fallen in her home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning assessments during the client's presurgical care, the nurse should be aware of the client's heightened risk of what complication? Osteomyelitis Avascular necrosis Phantom pain Septicemia

Avascular necrosis

Which of the following type of fracture is associated with osteoporosis? Compression Stress Oblique Simple

Compression

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear?

Difficulty lying on affected side Clients with a rotator cuff tear experience pain with movement and limited mobility of the shoulder and arm. They especially have difficulty with activities that involve stretching their arm above their head. Many clients find that the pain is worse at night and that they are unable to sleep on the affected side.

Colles fracture occurs in which area?

Distal radius A Colles fracture is a fracture of the distal radius (wrist). It is usually the result of a fall on an open, dorsiflexed hand.

Which term refers to the failure of fragments of a fractured bone to heal together?

Nonunion When nonunion occurs, the client reports persistent discomfort and movement at the fracture site. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Malunion refers to growth of the fragments of a fractured bone in a faulty position, forming an imperfect union.

Which is a hallmark sign of compartment syndrome?

Pain A hallmark sign of compartment syndrome is pain that occurs or intensifies with passive range of motion.

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

Prevent internal rotation of the affected leg. The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint. Postoperative total hip replacement clients may be turned onto the unaffected side. The hip may be flexed slightly, but it shouldn't exceed 90 degrees. Maintenance of flexion isn't necessary.

A client sprains an ankle while playing tennis and is brought to the emergency department. What is the priority action by the nurse?

Rest, ice, compression, and elevation A method for remembering the treatment for strains, contusions, and sprains is the mnemonic RICE, which refers to rest, ice, compression, and elevation. Sometimes, the letter S is added to the end to refer to stabilization. Nonsteroidal anti-inflammatory drugs may be prescribed to ease the discomfort but exercise is not advisable because the full use of the injured joint is discouraged temporarily.

A nurse advises a patient with a casted femur fracture to check for signs of a fat embolism. She tells the patient that the onset of symptoms for FES occur:

The onset of symptoms for a fat embolism is rapid, usually within 12 to 48 hours after injury, but may occur up to 10 days after injury.

A patient falls while skiing and sustains a supracondylar fracture. What does the nurse know is the most serious complication of a supracondylar fracture of the humerus?

Volkmann's ischemic contracture The most serious complication of a supracondylar fracture of the humerus is Volkmann contracture (an acute compartment syndrome), which results from antecubital swelling or damage to the brachial artery (Chart 43-3).

________________ are administered on arising in the morning with a full glass of water on an empty stomach, and the patient must stay upright for 30 to 60 minutes. calcium channel blockers antacids biphosphonates ace inhibitor

bisphosphonates

In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor in the client?

Compartment syndrome The nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable in a client with a dislocation to assess for compartment syndrome. It is a complication associated with dislocation. A client with a dislocation does not experience an increased risk of complications such as gastrointestinal bleeding, carpal tunnel syndrome, or ganglion cysts.

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture? Encourage participation in ADLs Promote intake of omega-3 fatty acids Use frequent dependent positioning to prevent edema Administer prescribed enema to prevent constipation

encourage participation in ADLS

A client who has fractured the radial head asks the nurse about factors that will promote bone healing. Which statement should the nurse include when responding to the client? Select all that apply.

"Immobilization of the fracture will promote healing by maximizing contact of bone fragments." "Fractured bones require a good blood supply and adequate nutrition for healing." "Weight bearing stimulates healing of the long bones of the leg, if the fracture is stabilized." Factors that enhance fracture healing include immobilization of the fracture fragments, sufficient blood supply, proper nutrition, and weight bearing for stabilized long bones of the lower extremities. Older adults heal more slowly. Corticosteroids inhibit the repair rate and can cause osteoporosis.

A client comes to the emergency department complaining of localized pain and swelling of his lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely?

Contusion The client's description of blunt trauma by a baseball bat and localized pain in conjunction with swelling and ecchymosis would most likely suggest a contusion. A fracture would be manifested by pain, loss of function, deformity, swelling, and spasm. A sprain would be manifested by pain and swelling; ecchymosis may appear later. A strain is characterized by inflammation, local tenderness, and muscle spasms

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

"Apply ice packs for the first 24 to 48 hours, then apply heat packs." The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching?

"I'll make sure to keep my ankle elevated as much as possible." Treatment consists of applying ice or a chemical cold pack to the area to reduce swelling and relieve pain for the first 24 to 48 hours. Elevation of the part and compression with an elastic bandage also may be recommended. After 2 days, when swelling no longer is likely to increase, applying heat reduces pain and relieves local edema by improving circulation. Full use of the injured joint is discouraged temporarily, not necessarily three to four weeks. Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically recommended; narcotic analgesics typically are not prescribed.

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply.

- skin breakdown - wound infection - pneumonia After surgery, the nurse implements measures to prevent skin breakdown, wound infection, pneumonia, constipation, urinary retention, muscle atrophy, and contractures.

A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of activity limitations when stating that a brace must be worn for which length of time?

6 to 8 weeks Following surgical repair for a ruptured Achilles tendon, the client wears a brace or cast for 6 to 8 weeks.

fractures

A comminuted fracture (Option A) is a bone that has splintered into several fragments. A fracture in which a bone fragment is driven into another bone fragment is called an impacted fracture (Option B). A transverse fracture (Option C) results in a break straight across the bone shaft. A fracture involving damage to the skin or mucous membranes is called an open or compound fracture (Option D).

When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction?

Apply ice to the fracture site. Applying ice to the injury site soon after an injury causes vasoconstriction, helping to relieve or prevent swelling and bleeding. Applying heat to the fracture site may increase swelling and bleeding. Ankle dorsiflexion has no therapeutic use after a toe fracture. It's unlikely the client would need crutches after a toe fracture.

A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin?

As soon as tolerated, after a reasonable period of immobilization Many impacted fractures of the surgical neck of the humerus are not displaced and do not require reduction. The arm is supported and immobilized by a sling and swathe that secure the supported arm to the trunk (Fig. 43-10). Limitation of motion and stiffness of the shoulder occur with disuse. Therefore, pendulum exercises begin as soon as tolerated by the patient. In pendulum or circumduction exercises, the physical therapist instructs the patient to lean forward and allow the affected arm to hang in abduction and rotate. These fractures require approximately 4 to 10 weeks to heal, and the patient should avoid vigorous arm activity for an additional 4 weeks. Residual stiffness, aching, and some limitation of ROM may persist for 6 months or longer (NAON, 2007).

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?

Between 24 and 48 hours After the acute inflammatory stage (e.g., 24 to 48 hours after injury), intermittent heat application (for 15 to 30 minutes, four times a day) relieves muscle spasm and promotes vasodilation, absorption, and repair.

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for:

Capillary refill. Assessment for neurovascular impairment includes checking for weak pulses or delayed capillary refill (normal is <2 seconds).

The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding?

Clawlike deformity of the right hand without ability to extend fingers A Volkmann's contracture is a claw like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. The client is unable to extend the fingers and complains of unrelenting pain, particularly if attempting to stretch the hand. Nodule on the knuckles and dislocation are not indicative of Volkmann's contracture.

Two days after application of a cast to treat a fractured femur, the client reports severe, deep, and constant pain in the leg. What willl the nurse suspect?

Compartment syndrome refers to the compression of nerves, blood vessels, and muscle within a closed space. This leads to tissue death from lack of oxygenation.

Which assessment findings would cause the nurse to suspect compartment syndrome after casting of the leg?

Complaints of numbness and tingling in toes of affected leg Numbness and tingling indicate nerve ischemia and edema, suggesting development of compartment syndrome.

A client presents to the emergency department with an open fracture. What is the first action the nurse should take?

Cover the exposed bone with sterile dressing. The exposed bone should be covered with a sterile dressing to protect the deeper tissues from contamination.

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture?

Encourage participation in ADLs General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation with ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care. Omega-3 fatty acids have no implications on the diet of a client with a fracture reduction. Dependent positioning may increase edema because the extremity is below the level of the heart. While some pain medications may contribute to constipation, this intervention would be reserved for a client experiencing constipation and not as a preventative measure.

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing

Fat embolism syndrome The clinical manifestations described in the scenarion are characteristic of fat embolism syndrome.

fat embolism s/s

Fat embolism syndrome is characterized by fever, tachycardia, tachypnea, and hypoxia. Arterial blood gas findings include a partial pressure of oxygen (PaO2) less than 60 mm Hg, with early respiratory alkalosis and later respiratory acidosis.

Which term refers to a break in the continuity of a bone?

Fracture A fracture is a break in the continuity of the bone. A malunion occurs when a fractured bone heals in a misaligned position. Dislocation is a separation of joint surfaces. A subluxation is a partial separation or dislocation of joint surfaces.

The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury?

Hypovolemic Hypovolemic shock resulting from hemorrhage is more frequently noted in trauma patients with pelvic fractures and in patients with a displaced or open femoral fracture in which the femoral artery is torn by bone fragments.

A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture

Incomplete A greenstick fracture involves a break through only part of the cross-section of the bone

Which nursing intervention is essential in caring for a client with compartment syndrome?

Removing all external sources of pressure, such as clothing and jewelry Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity.

An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as?

Subluxation A partial dislocation is referred to as a subluxation. A Volkmann's contracture is a claw like deformity that results from compartment syndrome or obstructed arterial blood flow to the forearm and hand. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space and affects nerve innervation, leading to subsequent palsy. A sprain is injury to the ligaments surrounding the joint.

When the client who has experienced trauma to an extremity reports severe burning pain, vasomotor changes, and muscles spasms in the injured extremity, the nurse recognizes that the client is likely demonstrating signs of

complex regional pain syndrome. Complex regional pain syndrome is frequently chronic and occurs most often in women. Avascular necrosis is manifested by pain and limited movement. Pain and decreased function are the prime indicators of reaction to an internal fixation device. Heterotrophic ossification causes muscular pain and limited muscular contraction and movement.

Which of the following is a term used to describe a soft tissue injury produced by a blunt force?

contusion A contusion is a soft tissue injury produced by blunt force, such as a blow, kick, or fall, that results in bleeding into soft tissues (ecchymosis, or bruising). A hematoma develops when the bleeding is sufficient to form an appreciable solid swelling. A strain, or a "pulled muscle," is an injury to a musculotendinous unit caused by overuse, overstretching, or excessive stress. A sprain is an injury to the ligaments and supporting muscle fibers that surround a joint often caused by a trauma, wrenching or twisting motion.

Which is not one of the general nursing measures employed when caring for the client with a fracture?

cranial nerve assessment Cranial nerve assessment would only be carried out for head-related injuries or diseases. General nursing measures include administering analgesics, providing comfort measures, assisting with ADLs, preventing constipation, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing client for self-care.

A nurse is inspecting the area of contusion and notes numerous areas of bruising. How would the nurse document this finding?

ecchymosis

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include:

inability to perform active movement and pain with passive movement. With compartment syndrome, the client can't perform active movement, and pain occurs with passive movement. A body-wide decrease in bone mass is seen in osteoporosis. A growth in and around the bone tissue may indicate a bone tumor.

Elderly clients who fall are most at risk for which injuries?

pelvic fractures Elderly clients who fall are most at risk for pelvic and lower extremity fractures. These injuries are devastating because they can seriously alter an elderly client's lifestyle and reduce functional independence. Wrist fractures usually occur with falls on an outstretched hand or from a direct blow. Such fractures are commonly found in young men. Humerus fractures and cervical spine fractures aren't age-specific.

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain?

rotator cuff tears Key assessment findings related to rotator cuff tears include acromioclavicular joint pain, limited range of motion, and muscle weakness. Epicondylitis (tennis elbow) is manifested by pain that usually radiates down the extensor surface of the forearm and generally is relieved with rest and avoidance of the aggravating activity. Heterotopic ossification is the abnormal formation of bone, near bones or in muscle, in response to soft tissue trauma after blunt trauma, fracture, or total joint replacement. Acute compartment syndrome involves a sudden and severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur.

A 14-year-old client is treated in the emergency room for an acute knee sprain sustained during a soccer game. The nurse reviews discharge instructions with the client's parent. The nurse instructs the parent that the acute inflammatory stage will last how long?

24-48 hrs Rest and ice applications during the first 24 to 48 hours produce vasoconstriction while decreasing bleeding and edema. After this time, the acute inflammatory stage decreases.

A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and observes petechiae on the client's chest. Which nursing action is indicated first? Elevate the affected extremity. Raise the head of the bed. Administer oxygen. Contact the health care provider.

Administer oxygen.

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect?

Avascular necrosis Avascular necrosis refers to the death of the bone from insufficient blood supply, typically manifested by complaints of increased pain and decreased function. Fever or redness, purulent drainage, and swelling of the site would suggest infection. Respiratory distress would suggest a pulmonary embolism. Changes in vital signs, level of consciousness, and signs and symptoms of fluid loss would suggest hypovolemic shock.

Which type of fracture is one in which the skin or mucous membrane extends to the fractured bone?

Compound A compound fracture is one in which the skin or mucous membrane wound extends to the fractured bone. A complete fracture involves a break across the entire cross section of the bone and is frequently displaced. An incomplete fracture involves a break through only part of the cross section of the bone. A simple fracture is one that does not cause a break in the skin.

A client was climbing a ladder, slipped on a rung, and fell on the right side of the chest. X-ray studies reveal three rib fractures, and the client reports pain with inspiration. What is the anticipated treatment for this client?

Coughing and deep breathing with pillow splinting Because these fractures cause pain with respiratory effort, the client tends to decrease respiratory excursions and refrains from coughing. As a result, tracheobronchial secretions are not mobilized, aeration of the lung is diminished, and a predisposition to atelectasis and pneumonia results. To help the client cough and take deep breaths and use an incentive spirometer, the nurse may splint the chest with his or her hands, or may educate the client on using a pillow to temporarily splint the affected site.

The nurses instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client?

Do not flex the hip more than 90 degrees. Proper alignment and supported abduction are encouraged for hip repairs. Flexion of the hip more than 90 degrees can cause damage to the a repaired hip fracture. By telling the patient to not to cross their legs, the leg stays in a the abducted position allowing for the hip to heal in the proper position. Having someone assist with the shoes does not allow for the hip to flex more than 90 degrees.

The primary nursing intervention that will control swelling while treating a musculoskeletal injury is:

Elevate the affected area. Elevation is used to control swelling. It is facilitated by cold, immobilization, and compression. Refer to Box 42-1 in the text.

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?

Elevating the stump for the first 24 hours Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. Bed rest isn't indicated and could predispose the client to complications of immobility. Heat application would be inappropriate because it promotes vasodilation, which may cause hemorrhage and increase pain. The initial pressure dressing usually remains in place for 48 to 72 hours after surgery.

Which of the following surgical procedures may need to be done when removing a cast or bandage does not restore circulation to the extremity?

Fasciotomy If pressure is not relieved by removing the bandage or cast and circulation is not restored, a fasciotomy may be necessary to relive the pressure within the muscle compartment. Hemiarthroplasty is the replacement of the femoral head with a prosthesis. An ORIF is done to reduce a fracture. A bone graft wound not be used to restore circulation.

The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the:

Femoral neck. A fracture of the neck of the femur may damage the vascular system and the bone will become ischemic. Therefore, a vascular necrosis is common.

A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient?

Hypovolemic shock Frequently, the patient develops shock, because the loss of 1,000 mL of blood into the tissues is common with fractures of the femoral shaft (ENA, 2013).

Which type of fracture involves a break through only part of the cross-section of the bone?

Incomplete An incomplete fracture involves a break through only part of the cross-section of the bone. A comminuted fracture is one that produces several bone fragments. An open fracture is one in which the skin or mucous membrane wound extends to the fractured bone. An oblique fracture runs across the bone at a diagonal angle of 45 to 60 degrees.

The nurse is caring for a patient who sustained an open fracture of the right femur in an automobile accident. What does the nurse understand is the most serious complication of an open fracture?

Infection In an open fracture, there is a risk for osteomyelitis, tetanus, and gas gangrene. The objectives of management are to prevent infection of the wound, soft tissue, and bone and to promote healing of bone and soft tissue.

A client who was in a motor vehicle crash is diagnosed with a stable T7 spinal fracture with no neurologic deficits. Which nursing intervention should the nurse implement?

Maintain bed rest with the head of the bed at 20 degrees. The client should maintain limited bed rest with the head of the bed lower than 30 degrees. If the client's pain is not controlled with a lower form of pain medication, then an opioid may be used to treat the pain. The nurse should monitor for an ileus. Stable spinal fractures are treated conservatively and not with surgical repair. The client should avoid sitting until the pain eases.

A client comes to the clinic 2 days after sustaining a sprain to the left ankle. What intervention can the nurse encourage the client to perform that will help improve circulation?

applying heat After 2 days, when swelling is no longer likely to increase, applying heat reduces pain and relieves local edema by improving circulation. Full use of the injured joint is discouraged temporarily. Nonsteroidal anti-inflammatory drugs will ease discomfort but not improve circulation. Applying cold compresses is only used in the first 24 to 48 hours after an injury to reduce swelling and relieve pain.

The most common causative organism of osteomyelitis is ________________. E. Coli Staph aureus pseudomonas acinetobacter

staph

Which nursing intervention is appropriate for minimizing muscle spasms in the client with a hip fracture?

Maintain Buck's traction. Buck's traction decreases pain, muscle spasm, and external rotation by immobilizing the hip fracture.

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?

A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment.

The type of fracture described as having one side of the bone broken and the other side bent would be:

A greenstick fracture is the type of fracture described as having one side of the bone broken and the other side bent. An oblique fracture occurs at an angle across the bone. A spiral fracture is a fracture that twists around the shaft of the bone. A transverse fracture is a fracture that is straight across the bone.

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?

Fat embolism Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the injury. It occurs when fat droplets released at the fracture site enter the circulation, become lodged in pulmonary capillaries, and break down into fatty acids. Because these acids are toxic to the lung parenchyma, capillary endothelium, and surfactant, the client may develop pulmonary hypertension. Signs and symptoms of fat embolism include an altered mental status, fever, tachypnea, tachycardia, hypoxemia, and petechiae. Compartment syndrome and infection may complicate any fracture and aren't specific to a pelvis fracture. Volkmann's ischemic contracture is a potential complication of a hand or forearm fracture.

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?

Impacted An impacted fracture is one in which a bone fragment is driven into another bone fragment. A comminuted fracture is one in which the bone has splintered into several fragments. A compression fracture is one in which bone has been compressed. A greenstick fracture is one in which one side of the bone is broken, and the other side is bent

A 19-year-old patient presents to the emergency room with an injury to her left ankle that occurred during a high school basketball game. She complains of limited motion and pain on walking, which increased over the last 2 hours. The nurse knows that her diagnosis is most likely which of the following?

Second-degree sprain A sprain is the result of an injury to ligaments that is caused by a twisting motion. A second-degree sprain is an incomplete tear of the ligament that results in painful weight bearing. A third-degree sprain involves a complete ligament tear with loss of weight-bearing function.

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

With the leg on the affected side abducted The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint.

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse?

"Describe the pain and rate it on the pain scale." The nurse should recognize phantom pain as real and complete a pain assessment as if the limb were attached. The client's pain should be address and treated appropriately. By telling the client that the toes have been amputated or the pain is really from the nerves in the upper leg, the nurse is negating the client's pain. Opioid pain medication can be effective with phantom pain.

Emergency medical technicians transport a client to the emergency department and inform the nurse that the client fell from a two-story building. The comatose client has a large contusion on the left side of the chest, a hematoma in the left parietal area, and a compound fracture of the left femur. The client was intubated and is maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse has the highest priority?

Assessing the left leg In this scenario, airway and breathing have been established, so the nurse's priority should be circulation. With a compound fracture of the femur, there is a high risk of profuse bleeding; therefore, the nurse should assess the left leg. Neurologic assessment of the pupils and LOC are secondary concerns to airway, breathing, and circulation. The nurse doesn't have enough data to warrant putting the client in Trendelenburg's position.

If a dislocation is not treated promptly, tissue death due to anoxia can occur. This would be documented as which of the following?

Avascular necrosis (AVN) If a dislocation is not treated promptly, AVN, tissue death due to anoxia and diminished blood supply, and nerve palsy may occur. Subluxation is a partial dislocation of the articulating surfaces. Heterotopic ossification is the abnormal formation of bone, near bones or in muscle, in response to soft tissue trauma after blunt trauma, fracture, or total joint replacement. Osteomyelitis is an acute or chronic inflammation of the bone caused by infection.

Pulselessness, a very late sign of compartment syndrome, may signify: Nerve involvement Venous congestion Diminished arterial perfusion Lack of distal tissue perfusion

Lack of distal tissue perfusion Pulselessness is a very late sign that may signify lack of distal tissue perfusion. The other answers do not apply.

Which factor inhibits fracture healing?

Local malignancy history of diabetes Factors that inhibit fracture healing include local malignancy, bone loss, and extensive local trauma. Factors that enhance fracture healing include proper nutrition, vitamin D, exercise, and maximum bone fragment contact.

A client is admitted to the hospital for a fracture of the right femur. Which clinical manifestation supports the diagnosis?

Right leg shorter than left A fractured lower extremity is often shorter than the unaffected one.

A client sustains an injury to the left ankle when he fell down three steps. There was immediate swelling and pain from the injury, and the client was taken to the local emergency department. What initial test does the nurse anticipate the physician will order to rule out a fracture?

X-ray X-rays may show a larger-than-usual joint space and rule out or confirm an accompanying fracture. Arthrography demonstrates asymmetry in the joint as a result of the damaged ligaments, or arthroscopy may disclose trauma in the joint capsule. A CT scan is costly and not used as a first-line diagnostic tool in the initial stage of an ankle injury.

Bursitis is an inflammation of a fluid-filled sac in the joint. True False

true

Nursing interventions for a patient undergoing foot surgery include a neurovascular assessment every 1 to 2 hours for the first 24 hours. True False

true

Osteoporosis frequently results in compression fractures of the spine, fractures of the neck or intertrochanteric region of the femur, and Colles fractures of the wrist. True False

true

A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? Select all that apply.

"I cannot seem to catch my breath." "I have a pins-and-needles sensation in my toes." Dorsiplantar weak and unequal bilaterally T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90% Fat embolism syndrome and compartment syndrome are complications of a fracture, especially of the long bones. Dyspnea, tachycardia, tachynea, fever, and low pulse oximetry would be indicators of fat embolism syndrome. Paresthesia (pins-and-needles sensation), limited motion, and motor weakness would be indicators of compartment syndrome. Capillary refill less than 3 seconds is a normal finding.

Which client(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply.

- The client with elevated pressure within the muscles - The client with hemorrhage in the site of injury - The client with a plaster cast applied immediately after injury Compartment syndrome occurs in cases of fracture when the normal pressure of a compartment is altered by the force of the injury itself, by development of edema, or by hemorrhaging at the site of the injury, which increases the contents of the compartment, or from outside pressure caused by constriction from a dressing or cast. A client with elevated muscle pressure is at risk for compartment syndrome. The application of a plaster cast immediately after the injury places the client at risk for compartment syndrome because the cast will not allow for edema and therefore will compress the tissue. Clavicle fractures are not a risk factor for compartment syndrome because of the location of the fracture. Ice will assist in decreasing edema and may help prevent compartment syndrome.

The patient presents to the emergency room with an open fracture of the femur. Which action would the nurse implement to prevent the most serious complication of an open fracture?

Cover the wound with a sterile dressing to prevent infection. The most important complication of an open fracture is infection. Therefore, the wound is covered with a sterile dressing. No attempt is made to reduce the fracture or apply pressure.

A client who suffers an injury in a local high school hockey game presents with left shoulder pain. The client cannot move the left arm, and the left shoulder is lower than the right shoulder. The nurse recognizes the client most likely has a:

Dislocated shoulder Clinical manifestations of a dislocated shoulder include pain, lack of motion, feeling of an empty shoulder socket, and uneven posture.

Which of the following disorders results in widespread hemorrhage and microthrombosis with ischemia?

Disseminated intravascular coagulation (DIC) DIC is a systemic disorder that results in widespread hemorrhage and microthrombosis with ischemia. AVN of the bone occurs when the bone loses its blood supply and dies. CRPS is a painful sympathetic nervous system problem. FES occurs when the fat globules released when the bone is fractured occludes the small blood vessels that supply the lungs, brain, kidneys, and other organs.

A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?

Keeping a pillow between the client's legs at all times After hip pinning, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period, because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After hip pinning, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.

Which nursing diagnosis takes highest priority for a client with a compound fracture?

Risk for infection related to effects of trauma A compound fracture involves an opening in the skin at the fracture site. Because the skin is the body's first line of defense against infection, any skin opening places the client at risk for infection. Imbalanced nutrition: Less than body requirements is rarely associated with fractures. Although Impaired physical mobility and Activity intolerance may be associated with any fracture, these nursing diagnoses don't take precedence because they aren't as life-threatening as infection.

A client reports pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The client was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury

sprain A sprain is an injury to the ligaments and tendons surrounding a joint, usually caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear.