NCLEX - ortho

how should you move a pt in traction

2 people 1 moves pt 1 moves weights without relieving traction *place knots in ropes so they dont slip

A nurse receives a client in the post anesthesia care unit following application of a long leg cast to the left leg due to a fractured tibia and fibula. Which interventions should the nurse initiate? You answered this question Correctly 1. Elevate foot of bed 30 degrees. 2. Palpate bilateral pedal pulses. 3. Apply ice packs to fracture site. 4. Mark break through bleeding. 5. Assess client's ability to move toes

2., 3., 4., & 5. Correct: The priority nursing assessment focuses on any intervention that maintains good circulation to the extremity and prevents complications that can impair mobility. This must include checking distal pulses in both legs to compare the strength of the pulse on both the affected and unaffected side. The nurse should also decrease swelling and risk of compartment syndrome by applying ice to fracture site, assess for bleeding, and check for tingling, coldness, numbness, and ability to move toes; in other words - neurovascular/sensation checks. 1. Incorrect: The affected leg should be elevated, but not both. The nurse should place the affected leg on a pillow and not raise the foot of the bed since this would raise both extremities.

difference between 3 point and 4 point crutch walking

3 point - affected leg doesn't touch ground d 4 point - bear weight on both crutches and both legs. right crutch with left foot

A nurse caring for a client diagnosed with osteomyelitis instructs an experienced unlicensed assistive personnel (UAP) to obtain vital signs on the client. Which value should the nurse tell the UAP to report immediately? You answered this question Incorrectly 1. Heart rate 98/min 2. Respirations 22/min 3. Blood pressure 138/82 4. Temperature 101°F (38.3°C)

4

what do total knee replacement pt do post op

CPM continuous passive motion

abduction or adduction

abduction keep legs apart

how to walk with a cane

affected leg and cane lands at same time

what should you do to prevent compartment syndrome

elevate soft cast first to allow for swelling then rigid cast

what kind of traction is used for pre-op hip replacement

bucks traction

what type of shock can you get with fractures

hypovolemic (pelvic, long bone fractures)

first thing to do with a fracture

immobilize with cast or splint move as little as possible -assess nuero status -redduce, fixation, traction, cast

what exercises can they do while in bed

isometric increases venous return

what does cpm do

keeps knee in motion and prevents formation of scar tissue

if a pt with a cast reports pain the first thing you should do is...

neurovascular checks

CPM teaching

never change setting give pain meds before put on clean surface when not in use (not on floor)

is it ok for limb to hang over bed

no

is it ok to sleep on operated side

no

how do you teach a pt to toughen the stump for the prothesis

press into soft pillow then firm pillow then bed then chair

Why is limb shaping important post amputation?

prosthesis -you want the end to be shaped like a cone (smaller and rounded at the bottom)

what is traction

pulling force in 2 different directions to reduce/immobilize a fracture **decreases muscle spasms

whats the best rehab exercise

walking swimming

are fiberglass casts waterproof

yes

will they be on prophy abx

yes

should you remove crusts from pin site

yes, bacteria will grow

what must always be at bedside with amputation pt

turnikit in case of massive hem

if pain is not relieve by elevation, cold packs, pain meds you should....

reassess in 30 if still in pain.. assume the worst

sx of fat embolism

restlessness hypoxia dyspnea petechia on chest

is skin or skeletal fraction used for prolonged traction

skeletal

skeletal vs skin traction

skin - tape/boot/splint is stuck to skin and weights pull against it sketetal - traction applied to bone with pins/wire

how to walk with walker

step into it! move 1 ft forward walk into it with your injured leg first

why would you use a trochanter roll

to prevent external rotation

is phantom pain more common with AKA or BKA

AKA usually subsides in 3 months

what kind of mattress for post op hip replacement

firm ortho pts require firm mattress

A child with a radial fracture reports itching below the casted area. What is the appropriate nursing action to relieve itching? You answered this question Incorrectly 1. Allow the child to use a Q-tip to scratch the area. 2. Assess the fingers and areas above the cast to identify areas of irritation. 3. Apply an ice pack for 10-15 minutes. 4. Explain to the child that itching is an indication the fracture is healing.

3. Correct: This will change the sensation. Normally the answer is use a cool blow dryer, but they wanted to see if you would be flexible with what you know. Use an ice pack that will not get the cast wet. 1. Incorrect: A Q-tip is soft, trying to make you feel like this is okay to put into a cast. 2. Incorrect: How does assessing the fingers decrease itching? It doesn't. 4. Incorrect: How does explaining the pathophysiology help decrease itching? It doesn't.

elevation post op what to elevate it on

first 24 hrs if prescribed then dont elevate anymore b/c of contractures dont elevate it on a pillow elevate the foot of bed lay prone a few times a day

An 18 year old football player is admitted to the ortho unit after a femur fracture. He is scheduled for a rod to be placed in the morning, but suddenly develops severe shortness of breath, a petechial rash on his chest, and unstable vital signs. What should the nurse do first? You answered this question Incorrectly 1. Decrease rate of IV fluids. 2. Neurovascular checks of affected leg. 3. Elevate the head of the bed. 4. Call the active response team.

4. Correct: The client is exhibiting symptoms of a fat embolism, particularly with the petechial rash on his chest and severe shortness of breath. Due to his age, high risk behaviors with contact sports, and the large long bone fracture, he is the classic example of a client that may experience a fat embolus. This constitutes a medical emergency and activation of the response team. 1. Incorrect: This does not affect breathing here and will do nothing to resolve the fat embolism. 2. Incorrect: Neurovascular checks of the leg will not help the client's breathing and are not the first priority for the nurse. 3. Incorrect: The nurse may elevate HOB to assist with breathing unless client is hypotensive. Either way, this is not the best first answer.

highest risk period for a fat embolism

first 36-72 hrs

lay up or flat for post op

flat prevent extension only raise HOB for meals

compartment syndrome patho

fluid accumulates in tissue and impairs tissue perfusion muscle becomes swollen and hard pt reports severe pain

weights should hang....

freely, never on floor dont remove weights or lift them

A client who has a long leg cast is reporting unrelieved pain. What should the nurse do first? You answered this question Incorrectly 1. Apply a warm compress 2. Elevate and reposition the leg 3. Assess for breakthrough bleeding on the cast 4. Monitor extremity for paresthesia

4. Correct: Yes, because I am worried about compartment syndrome! Do a complete neurovascular assessment. Remember the 5 Ps: pain, pallor, pulse, paresthesia, and paralysis. 1. Incorrect: Avoid warmth because it may cause vasodilation and worsen the compartment syndrome. 2. Incorrect: The nurse should elevate the extremity to decrease swelling, but it is not the priority over assessing neurovascular status. 3. Incorrect: This is not a priority over neurovascular assessment.

Tx for compartment syndrome

notify provider elevate extremity loosen cast assist with fasciotomy

most common type of skin traction what is it used for

bucks boot applied, immobilizes lower limb hip and femoral fractures

reduction vs fixation

REDUCTION: closed - manual manipulation open - surgical FIXATION: internal - follows open reduction, screws/plates external - external screws/plates

Is it ok to massage the stump?

-promotes circulation and decreases tenderness

how far below axilla should crutches be

1-2 inches

Which statements should the nurse include when teaching a client about osteomyelitis? You answered this question Incorrectly 1. Osteomyelitis is a risk factor for people who have chronic illnesses. 2. Activity restriction is necessary to avoid stress on the affected bone. 3. Intravenous antibiotics will be administered for at least 3 to 6 weeks. 4. High calcium levels may occur so report muscle weakness, anorexia, nausea and vomiting. 5. Osteomyelitis requires subcutaneous administration of calcitonin to reverse the course of the disease.

1., 2, & 3. Correct: Clients who are at high risk for osteomyelitis include those who are poorly nourished, elderly, or obese. Others at risk include those with impaired immune systems and chronic illnesses such as diabetes and rheumatoid arthritis. Treatment regimens restrict activity. The bone is weakened by the infective process and must be protected by immobilization devices and by avoidance of stress on the bone. IV antibiotic therapy is provided for a period of 3-6 weeks with around the clock dosing to maintain a high therapeutic blood level. 4. Incorrect: Hypercalcemia is a complication associated with bone cancer, not osteomyelitis. 5. Incorrect: Calcitonin is used for Paget's disease. A disorder of localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae. Osteomyelitis is an infection of the bone. Bones can become infected in a number of ways: Infection in one part of the body may spread through the bloodstream into the bone, or an open fracture or surgery may expose the bone to infection. In most cases, Staphylococcus aureus causes osteomyelitis. The condition affects children and adults, although in different ways. Certain conditions and behaviors that weaken the immune system increase a person's risk for osteomyelitis, including: diabetes, sickle cell disease, HIV or AIDS, rheumatoid arthritis, IV drug use, alcoholism, long-term steroid use, hemodialysis, poor blood supply, or recent injury. Bone surgery, including hip and knee replacements, also increase the chance of bone infection. Acute osteomyelitis develops rapidly over a period of seven to 10 days. The symptoms for acute and chronic osteomyelitis are very similar and include: fever, irritability, fatigue, nausea, tenderness, redness, and warmth at the infection site, swelling around the affected bone, and lost range of motion.

A client is preparing to be discharged after a total hip replacement. Which client statements would indicate teaching has been successful regarding prevention of hip prosthesis dislocation? You answered this question Correctly 1. "I should not cross my affected leg over my other leg." 2. "I should not bend at the waist more than 90 degrees." 3. "While lying in bed, I should not turn my affected leg inward." 4. "It is necessary to keep my knees together at all times." 5. "When I sleep, I should keep a pillow between my legs."

1., 2., 3. & 5. Correct: These are appropriate actions to prevent hip prosthesis dislocation. Until the hip prosthesis stabilizes it is necessary to follow these instructions for proper positioning to avoid dislocation. 4. Incorrect: The knees should be kept apart to prevent dislocation.

What signs and symptoms should the nurse expect to find during the physical assessment of a client who has a history of rheumatoid arthritis? You answered this question Incorrectly 1. Firm nodules under the skin 2. Reports of morning stiffness lasting for hours 3. Reports of fatigue 4. Cool, swollen joints 5. Joint deformity

1., 2., 3., & 5. Correct: Firm bumps of tissue under the skin, most often on elbows, are called rheumatoid nodules, and are a sign of rheumatoid arthritis. Morning stiffness that can last for hours is a symptom of rheumatoid arthritis. Over time, rheumatoid arthritis can cause joints to deform and shift out of place. Fatigue is a common symptom of rheumatoid arthritis. 4. Incorrect: Affected joints will be tender, red, warm, and swollen.

A client diagnosed with rheumatoid arthritis has been prescribed celecoxib. What should the nurse include in the client's education regarding this medication? You answered this question Incorrectly 1. Do not take celecoxib with ibuprofen. 2. GI complaints and headache are among the most common side effects. 3. Drink a lot of water to offset the dehydration that may occur. 4. Notify the healthcare provider immediately if black stools are noted. 5. This medication provides relief of pain and swelling so you can perform normal daily activities.

1., 2., 4., & 5. Correct: Concomitant use of celecoxib with aspirin or other NSAIDs (for example, ibuprofen, naproxen, etc.) may increase the occurrence of stomach and intestinal ulcers. This would increase the risk of GI bleeders. GI complaints and headache are two of the most common side effects. The client should stop taking celecoxib and get medical help right away if the client notices bloody or black/tarry stools. This would be an indication of GI bleeding. This medication is a nonsteroidal anti-inflammatory drug (NSAID), which relieves pain and swelling. It is used to treat arthritis. The pain and swelling relief provided by this medication should help the client perform normal daily activities. 3. Incorrect: The client may develop fluid retention while taking this medication. They should decrease the intake of sodium to decrease fluid retention.

An elderly client arrives in the emergency department (ED) after a fall. What assessment findings would lead the nurse to suspect that the client has a fractured right hip? You answered this question Incorrectly 1. Severe pain in the right hip and groin. 2. Inability to bear weight on the right leg. 3. Right leg slightly longer in length than the left leg. 4. External rotation of right lower leg. 5. Bruising and swelling around the right hip.

1., 2., 4., & 5. Correct: Pain in the affected hip, often severe, is one of the main signs of a hip fracture. This pain may radiate to the groin area. The pain and bone injury generally prevent the client from being able to bear weight on the affected leg. The client will often assume a position in which the leg on the injured side is held in a still and externally rotated position (the foot and knee turns outward). Discoloration and swelling can be an indication of a hip fracture in some clients. 3. Incorrect: A client who has a hip fracture often appears to have shortening of the extremity on the affected side. This is a result of the location of the break and the positioning of the body in response to the injury and pain.

A petite female client presents to the clinic with symptoms of back pain and states, "I think I am getting shorter." Which teachings would be appropriate for the nurse to provide? You answered this question Incorrectly 1. Spend time in the sunlight twice a week for 5 to 30 minutes. 2. Wear low heeled, nonslip sole shoes for traction. 3. Walk at least 30 minutes most days. 4. Include yogurt and cheese in diet. 5. Take regularly scheduled prescribed corticosteroids.

1., 2.,3. & 4. Correct: The client with osteoporosis is usually female, small framed and back pain from collapsed vertebrae and shortening are symptoms. Exposure to light converts vitamin D stores in the skin. Low-heeled, nonslip soled shoes are a safety issue to prevent loss of balance and falls. Weight bearing exercises like walking will promote bone density. Yogurt and cheese are high in calcium. 5 Incorrect: This individual should not be taking corticosteroids as these drugs will promote the loss of calcium.

Following a total hip replacement, the nurse provides discharge teaching to the client. The nurse knows that teaching was effective when the client states which activities are safe to perform? You answered this question Correctly 1. Using an abduction pillow while sleeping 2. Crossing the legs 3. Using a toilet extender 4. Showering rather than taking a bath 5. Tying shoes

1., 3., & 4. Correct: The client should use an abduction pillow to keep hip in proper alignment and prevent hip dislocation. A toilet extender keeps the hip in proper alignment and prevents hip dislocation. Showering rather than sitting in a tub will prevent flexion of the hip. 2. Incorrect: Crossing the leg can pop the hip out of place and prevent total healing and success with the replacement. 5. Incorrect: To tie shoes, the client has to bend over which can pop the hip out of place. The client would need to have shoes that do not require tying or have someone do it for them.

A client being treated for osteoporosis with alendronate reports experiencing slight heartburn after taking the medicine. What should the nurse suggest to reduce this side effect? You answered this question Correctly 1. Stop taking the medication and call the primary healthcare provider. 2. Drink plenty of water with the medication. 3. Take the medication before bedtime. 4. Take antacids when taking the medication.

2. Correct: Increased heartburn can be reduced or prevented by drinking plenty of water, sitting upright following the administration of the medication, and avoiding sucking on the tablet. 1. Incorrect: Slight heartburn does not warrant primary healthcare provider report. Extreme pain or difficulty swallowing should be reported, as should heartburn that increases despite suggestions listed above. 3. Incorrect: The client should take in the morning, thus preventing prolonged contact with the esophagus. 4. Incorrect: The absorption of the medication is decreased when it is taken with calcium, iron, and magnesium, or antacids containing calcium, aluminum, or magnesium. Thirty minutes should elapse before taking the antacid following administration of the alendronate.

The nurse observes an unlicensed assistive personnel (UAP) performing AM care for a client with a plaster leg cast applied 12 hours ago. Which action by the UAP should the nurse intervene? You answered this question Correctly 1. Lifting the affected leg with the palms of the hands 2. Covering the affected leg with a blanket to avoid chills 3. Placing plastic over the entire cast prior to bathing 4. Elevating the casted leg on two pillows

2. Correct: Plaster cast take 24-48 hours to completely dry. During this time they release heat. The new cast should not be covered so that heat from the cast can evaporate. If the heat is not allowed to dissipate, drying will take longer. 1. Incorrect: Plaster cast take 24-48 hours to completely dry. During this time the cast should be handled carefully as to avoid indentations. Handling the cast carefully with the palms and not the fingertips will prevent indentations. Indentations in the cast could cause skin breakdown inside the cast. 3. Incorrect: Yes, will keep cast from getting wet. Plaster casts should never get wet. The plaster cast does not hold up well in water. Wet casts can also irritate the skin underneath. 4. Incorrect: Yes, may elevate the leg. Fractures are prone to swelling. Elevating fractures while casted is a common occurrence. Elevation prevents swelling.

The charge nurse is observing a nurse perform a dressing change on a client with a Stage III pressure ulcer. What observation by the charge nurse would indicate a need for further teaching? You answered this question Correctly 1. Irrigates the pressure ulcer with 50 mL normal saline. 2. Irrigates the pressure ulcer with half-strength hydrogen peroxide. 3. Packs the wound with sterile gauze soaked in normal saline. 4. Applies a hydrocolloid dressing over the wound after cleansing.

2. Correct: Pressure ulcers should not be cleaned with substances that are cytotoxic such as hydrogen peroxide, betadine or Dakin's solution. Cytotoxic means toxic to cells, or cell-killing. Any agent or process that kills cells. These solutions can kill or damage cells, especially fibroblasts. Dakin's solution is a type of hydrochlorite solution. It is made from bleach that has been diluted and treated to decrease irritation. Chlorine is the active ingredient in Dakin's solution. 1. Incorrect: Normal saline is an appropriate solution and is used to clean pressure ulcers. This does not kill or damage cells. 3. Incorrect: Normal saline is an appropriate solution and pressure ulcers may be packed with sterile gauze. This helps remove necrotic tissue. 4. Incorrect: The wound should be covered with an appropriate dressing after cleaning. Hydrocolloid dressings support healing in clean granulating wounds and autolytically debride necrotic wounds. Hydrocolloid dressings are occlusive, so they provide a moist healing environment, autolytic debridement, and insulation.

A nurse receives a client in the post anesthesia care unit following application of a long leg cast to the left leg due to a fractured tibia and fibula. Which interventions should the nurse initiate? You answered this question Incorrectly 1. Elevate foot of bed 30 degrees. 2. Palpate bilateral pedal pulses. 3. Apply ice packs to fracture site. 4. Mark break through bleeding. 5. Assess client's ability to move toes

2., 3., 4., & 5. Correct: The priority nursing assessment focuses on any intervention that maintains good circulation to the extremity and prevents complications that can impair mobility. This must include checking distal pulses in both legs to compare the strength of the pulse on both the affected and unaffected side. The nurse should also decrease swelling and risk of compartment syndrome by applying ice to fracture site, assess for bleeding, and check for tingling, coldness, numbness, and ability to move toes; in other words - neurovascular/sensation checks. 1. Incorrect: The affected leg should be elevated, but not both. The nurse should place the affected leg on a pillow and not raise the foot of the bed since this would raise both extremities.

how many months should you limit stress to the hip

3-6 mo

A nurse has received report on a client to be admitted from the surgical suite following an unexpected amputation of the right arm because of a tractor accident. Which action by the nurse would best help the client upon arrival to the unit? You answered this question Incorrectly 1. Notify hospital social services about adaptive equipment needs. 2. Prepare to change the dressing so the client can see the stump. 3. Ask client's family and hospital chaplain to be present in room. 4. Advise dietary that client will need food precut in small pieces.

3. Correct. This client will be awake from surgery to face the unexpected amputation of an arm, which has long-term physical, psychological, emotional and financial implication. Even clients facing a scheduled limb removal experience distress, anger or depression. Anticipating that the client will need a great deal of emotional support, the nurse is aware that having family and/or the hospital chaplain present after surgery may help the client cope with the bad news. 1. Incorrect. Losing an extremity involves relearning how to complete ADL's in an alternative manner and usually requires using adaptive equipment. This client may be introduced to specialty equipment prior to discharge, and social services will arrange for any home care needs. However, this action is not of primary concern at the time of the clients arrival in the unit. 2. Incorrect. The loss of a limb, particularly unexpectedly, can overwhelm a client and result in feelings of shock, anger, or even denial. Clients can experience a range of emotional responses based on age, beliefs, values or social support. One common behavior among new amputees is the hesitancy to look at the stump. Forcing the client to visualize the wound before being psychologically ready can hinder or delay adaptation. Additionally, the surgeon generally removes the original surgical dressing. 4. Incorrect. This client will need to learn many adaptive skills once the surgical site has healed. However, having food precut into small pieces diminishes self-esteem and discourages client independence, which is important to recovery. An occupational therapist will be consulted regarding special eating utensils and techniques but usually there is little alteration in the preparation of food.

An infant has been prescribed Bryant's traction for a diagnosis of developmental dislocated hips (DDH). At what degree of hip flexion should the nurse maintain the infant's hip for proper traction alignment? You answered this question Incorrectly 1. 15 2. 30 3. 45 4. 90

4. Correct: Bryant's traction is used for DDH. The child's body and the weights are used as tension to keep the end of the femur in the hip socket. Traction helps position the top of the femur into the hip socket correctly. This is accomplished with 90 degrees of hip flexion. 1. Incorrect: Fifteen degrees of flexion is not adequate to keep the femur end in the hip socket. 2. Incorrect: Thirty degrees of flexion is not adequate to keep the femur end in the hip socket. 3. Incorrect: Forty-five degrees of flexion is not adequate to keep the femur end in the hip socket.

How does the nurse identify the correct size of crutches for a client? You answered this question Incorrectly 1. Turn the crutches upside down and measure from the heel to the shoulder. 2. Obtain a set of crutches and adjust the height until the client can stand comfortably while resting the axilla on the crutch pad. 3. Measure the client while standing upright from the axilla to the heel then adjust the crutches so that the elbow flexion is a 30-degree angle. 4. Measure the client from 2 inches below the axilla to 6 inches lateral to the client's heel.

4. Correct: Measuring the client from 2 inches below the axilla to 6 inches lateral to the client's heel correctly measures a client for crutches. This is the correct size while a client is standing. 1. Incorrect: This is not the correct way to choose the correct size crutches. Without the proper fit safety is a concern. 2. Incorrect: This is not how to choose the correct size of crutches. The client should not rest their weight on the crutch pad as this can cause damage to the brachial plexus nerve. 3. Incorrect: This is not how to choose the correct size of crutches. The shoulders should be relaxed, the hand piece should be adjusted to provide a 20°- 30° elbow flexion. The 2 inch drop below the axilla allows the weight to be pressed against the sides and the hands absorb the weight. The crutch should not be placed against the axilla or the brachial plexus nerve could be damaged.

how to sit with a walker

back up to the chair feel it with your hands

what is the first intervention to decrease phantom pain

diversional activity medicine is last resort

if there is an open fracture, first thing to do is...

splint and cover with a sterile dressing

sterile or clean for pin care

sterile

what should you do if a pin falls out

take over role of pin immobilize! cover hole

plaster cast care

takes 24-72 hrs to dry (keep uncovered) keep cast elevated on pillow (not a hard surface) handle with palms of hands monitor neurovascular check can use hair dryer on cool setting to dry

why is it important to strengthen the upper body

they will be using crutches or a walker to ambulate

cane goes on which side

unaffected

sx of compartment syndrome

unrelieved pain pain disproportionate to injury pale/dusky distal to area

how to walk up stairs with crutches how to walk down

up - good foot, bad foot raised behind down - bad foot raised in front, hop down each stair on good foot